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What does the following diagnosis after a skin punch biopsy mean?

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Posted on Tue, 30 Dec 2014
Question: After a skin punch biopsy. the following diagnosis was made: Mild perifollicullar fibrosis and chronic inflammation. Is this reversible? If so, what medication is recommended?

*This is in regards to discoloration patches on my scalp. I keep my head clean shaven.
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Answered by Dr. Kakkar S. (3 hours later)
Brief Answer:
Pseudopelade

Detailed Answer:
Hello. Thanks for writing to us at heathcaremagic

I have gone through your query and I have also seen the Images

I will keep a possibility of Pseudopelade, probably secondary to Lichen Planus Pigmentosus (LPP) of the scalp.
In the Image it looks like a burnt out disease i.e end stage disease.
There is cicatricial alopecia as also substantiated by biopsy which shows Perifollicular fibrosis. Cicatricial alopecia is permanent.
Oral steroids can be tried, however, it remains to be seen if hair follicles recover on treatment and to what extent, because there already is perifollicular fibrosis, though it is mild. Recovery may be partial.
I would suggest that you visit a dermatologist in your region for the needful.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Kakkar S. (15 hours later)
Thanks for your input. I am actually not concerned with recovering follicles as I said I keep my head clean shaven. I am more interested in stopping the spread of the patches or reversing the effect. Is oral steroid the recommended first step? what about steroid creams? I plan on printing your input and sharing with local dermatologist here also.
doctor
Answered by Dr. Kakkar S. (2 hours later)
Brief Answer:
Topical steroids would help lighten patches

Detailed Answer:
Hi

The discoloured patches are due to post inflammatory hyperpigmentation and hypopigmentation.
Yes topical steroids would help lighten dark patches. However, the results are slow because pigmentation is usually deeper in LPP.
Oral steroids are mainly to arrest progression/activity of disease and reverse early stage disease.
However, if the disease has already progressed to end stage i.e has left behind dark coloured/hyperpigmented smooth atrophic patches of cicatricial alopecia, then Oral steroids are of no use.
Sure you can share this discussion with your local dermatologist and do let me know how your dermatologist decides to approach it.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (1 hour later)
Thanks again. Will share what you have said with dermatologist. Note that patches are already lightened not darkened. See pic i sent earlier. I meant was there a cream that would even out my scalp color all over. Unless im misunderstanding what you meant? pls suggest some steroid creams and oral steroids so that i can also share with dermatologist here. thanks
doctor
Answered by Dr. Kakkar S. (20 minutes later)
Brief Answer:
Potent topical steroids

Detailed Answer:
Hi

You have both light coloured patches(Depigmented patches) as well as hyperpigmented patches/dark patches along with cicatricial alopecia. These both are a result of inflammation resulting from the disease process in LPP. The biopsy is too typical of LPP and in the report the doctor just falls short of mentioning the diagnosis.
In such cases I would normally suggest a potent topical steroid containing either clobetasol propionate Or Betamethasone dipropionate.
These are prescription steroids and therefore you would need a prescription from your treating dermatologist.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Kakkar S.

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What does the following diagnosis after a skin punch biopsy mean?

Brief Answer: Pseudopelade Detailed Answer: Hello. Thanks for writing to us at heathcaremagic I have gone through your query and I have also seen the Images I will keep a possibility of Pseudopelade, probably secondary to Lichen Planus Pigmentosus (LPP) of the scalp. In the Image it looks like a burnt out disease i.e end stage disease. There is cicatricial alopecia as also substantiated by biopsy which shows Perifollicular fibrosis. Cicatricial alopecia is permanent. Oral steroids can be tried, however, it remains to be seen if hair follicles recover on treatment and to what extent, because there already is perifollicular fibrosis, though it is mild. Recovery may be partial. I would suggest that you visit a dermatologist in your region for the needful. Regards