What does the following diagnosis after a skin punch biopsy mean?
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.
Topical steroids would help lighten patches
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.
Potent topical steroids
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.
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