Scarring Alopecia - Question and Answer Session

In this video, Dr. Donovan answers 31 questions related to scarring alopecia that were submitted by participants of a September 2021 live public webinar.

Questions are summarized below with time stamps to facilitate easy access.


Q1. (see question at 1:26) Does telogen effluvium ever form scars?


Q2. (see question at 1:59) For patients with FFA do you order hormone levels prior to ordering finasteride or dutasteride? If levels are drawn do you refer the patient to an endocrinologist or do you evaluate the lab results and prescribe accordingly? Do you prescribe without lab values?



Q3 (see question at 4:33) I was diagnosed with LPP in April 2021. Prescribed hydroxychloroquine 200 mg once per day and minoxidil once per day. I was also given steroid injections in scalp in April. On return visits there has been no sign of inflammation. Two years ago I had lichen planus all over my body. Three drs said the worst case they had ever seen. Tried prednisone, phototherapy…both did nothing. Started Methotrexate and was on that for about 12 months. It cleared the LP and it has not returned. My question is should I be on methotrexate now for LPP considering my history?


Q4. (see question at 6:50) Second question….it seems that LPP and LP initially were activated after being given steroids/anti inflammatory meds for other issues…could the LP and LPP be activated by this?


Q5. (see question at 10:01). I was diagnosed with LPP and AA nearly a year ago. I am under a dermatologist. So far, I have only been given Elocom cream to use for 6 weeks and still getting itching. Thankfully no further hair loss than the small area on the hairline


Q6. (see question at 11:31) What is meant by burnt out scarring alopecia?


Q7. (see question at 15:44) My biopsy says I have mild inflammation. What does this mean?


Q8. (see question at 17:10) How often does LPP and FFA occur in the same patient?
Is LPP the same as FFA? What type of environmental factors might be relevant in scarring alopecia?


Q9. (see question at 22:28): I have had LPP for a year and thankfully not got worse. So far only used steroid cream . Could this be it? Or am I being too. Optimistic?


Q10. (see question at 23:40). Is the risk of rosacea increased in FFA?


Q11. (see question at 24:22) I have CCCA and fibroids. Is there known to be a risk of fibroids in CCCA?


Q12. (see question at 24:56) Can LPP be caused by medications ?


Q13. (see question at 25:49) What is the minimum of time between two sessions of steroid injections in FFA?


Q14. (see question at 28:16) Can LPP affect the whole scalp?


Q15. (see question at 28:33) I have folliculitis decalvans and my doctor wants to give me steroid injections. Won’t it make it worse if it’s caused by infection?


Q16. (see question at 29:57) I have CCCA. Should I do doxycycline or steroid injections?


Q17. (see question at 31:38) What supplement should a person with scarring alopecia take?


Q18. (see question at 32:57) I would like to have a hair transplant but I read mixed things. Is it safe for a person with scarring alopecia? I have lichen planopilaris.


Q19. (see question at 34:24) How likely is it that a topical steroid will stop my LPP and that’s all I will need?


Q20. (see question at 35:36) Does finasteride cause breast cancer ? I have been recommended it for my FFA.


Q21. (see question at 39:31) Are there any over the counter products that help scarring alopecia?


Q22.. (see question at 40:52) I had a biopsy that showed I have scarring alopecia. Will I need to get another one to see if it is dormant?


Q23. (see question at 42:07) For a patient diagnosed with LPP, what antibiotics if any would you suggest. Also should I be taking high doses of Vitamin D?


Q24. (see question at 43:33) Can you put or use hair dye and is there a particular chemical to avoid or look out for?


Q25. (see question at 45:40) Does LPP typically improve if other health issues (e.g. gut / nutrition, thyroid, stress) are brought under control?


Q26. (see question at 47:48) Does an autoimmune diet help? Do you need to cut our dairy and gluten?


Q27. (see question at 49:26) Is Titanium Dioxide the culprit to halt loss?

Q28. (see question at 50:16) What does inflammation mean? Is that bad for you?


Q29. (see question at 51:29) Do you recommend PRP or Light Therapy?

Q30. (see question at 52:35) What about shampoos? Are there any that are recommended?


Q31. (see question at 54:28) I was prescribed a JAK inhibitor cream for my frontal fibrosing alopecia (FFA). I know it is newly FDA approved for alopecia areata. Do you know anything about the efficacy for cicatricial alopecia?