Microneeedling for Scarring in Lichen Planopilaris

Microneeedling for LPP Scars

I’ve selected this question below for this week’s question of the week. It allows us to review the concept of microneedling for lichen planopilaris-related scars.

Question

Does micro-needling help hair regrowth in and around the white scarred areas left by Lichen Planopilaris? If so, is there a particular type of micro-needling that is more effective for this than another? I have had acupuncture in the white scarred areas left by my Lichen Planopilaris for about 6 months and some of those areas have become less hard and more pinkish like regular scalp, with some small hairs starting to grow. My understanding is that: 1) micro-needling is similar to acupuncture in that it draws more bloodflow to those parts of the scalp, thus stimulating more hair growth; 2) micro-needling is likely to be more effective since the "pens" used to do it provide more needle punctures in a small area than can practically be done with single acupuncture needles. Given the hopeful results I have seen from acupuncture, I hoping that micro-needling would provide even better re-growth results.

Answer

Thanks for the question.

We don’t have any evidence right now that microneedling helps regenerate hair to any significant degree for patients with LPP. We have studied it without any good evidence.

For true white scarred areas in LPP, scalp biopsies show us that there are usually not many hair follicles underneath that can be stimulated. Most of the hair loss in scared white patches of LPP are permanent because the follicles have been destroyed. Stem cells in highly scarred area are often completely gone which limits regrowth in LPP.

Now there can be a few hairs from time to time but we don’t have evidence that use of microneedling or acupuncture leads to much in the way of significant hair regrowth. I’m never against a patient trying, provided they try a small area first and provided they are aware that sometimes acupuncture and microneedling actually flares LPP patches and just reactivates the disease.

We have not seen regrowth in scarred areas.