I'm 26 and started losing hair around 19ish, and by 22ish it was noticable, and I started noticing shiny spots on my forehead, where there used to be hair.

A couple of years ago I decided to do something about this hair loss and redness, and went to a dermatologist to see if the shinyness and hair loss is related. Went to 4 different dermatologists, each one had a different say on the shiny spot (it was slightly red also).

The last dermatologist sympathized and ordered a biopsy (the text follows), but basically seemed like another inconclusive road. The doctor ordered ANA, which was negative. To be honest I think the doctor ordered ANA because she probably was most familiar with it.

Anyway, she ordered topical steroids, and well nothing much has changed, up until now -- I went to hairtransplant surgeon, and showed him the spots, he is now concerned if the transplant will be attacked by the "whatever" disease might be at work.

I'm looking to find out if someone can make more sense for me, give me percentages on what it could be, etc.

Biopsy:

Clinical Data:

"24-year-old male, bitemporal hair thinning with lichenoid pigment changes. Rule out discoid lupus, lichen plauns.”

Gross Description:

A) The specimen is received in formain labeled “Sabharwal” is a 4mm, dark brown, hair bearing, punch-like biopsy of skin that is excised to a depth of 0.3 cm. The specimen is inked, bisected and entirely submitted in cassette A1.

Microscopic Description:

A) Sections of hyperkeratotic skin with mild epidermal hyperplasia without interface degeneration of the epidermis. Some of the follicles are small and are associated with inflammation. The dermis shows patchy perivascular lymphoplasmacytic inflammation. One follicle shows hyperkeratosis, mild perifollicular lymphocytic inflammation, mild interface change, and mild fibrosis at the level of the isthmus. There are also rare apoptotic keratinocytes. There are also foci of hypervascular connective tissue with chronic inflammation consistent with follicular destruction. Scattered melanophages are seen in the papillary dermis. Extravasated erythrocytes are present around follicles. A PAS stain is negative for fungal elements. Brown and Brenn stain is negative for bacterial organisms. Colloidal iron stains with and without hyaluronidase show focally increased mucin in the superficial dermis. No polarizable foreign material is identified. Additional step sections are examined.

FINAL DIAGNOSIS:

A) Skin, left temple, biopsy:
1) Changes suggestive of androgenetic alopecia
2) Focal follicular destruction, perifollicular fibrosis, chronic inflammation, and erythrocyte extravasation.
3) A Brown and Brenn stain for bacteria and PAS stain for fungi were performed and were negative
4) See comment.

COMMENT:

A) These vertical sections do show a tendency for small hair follicles that would be suggestive of androgenetic alopecia; however, there is significant perifollicular inflammation and follicular destruction in at least one follicular unit. This finding would not be in keeping with androgenetic alopecia and suggests a second process. The histologic differential diagnosis includes discoid lups erythematosus, lichen plano-pilaris, physical trauma.
Although ascorbic acid deficiency is rare in our patient population, the prominent erythrocyte extravasation raises that consideration. Among these possibilities, the finding would be most suggestive of discoid lupus.
Additional biopsies and/or direct immunofuorescene studies may be contributory. Clinical correlation is necessary.