Lichen Planopilaris

Lichen planopilaris (LPP) is an uncommon inflammatory condition that affects the hair follicles, primarily on the scalp, leading to scarring hair loss (cicatricial alopecia). It is characterised by redness, scaling, and follicular hyperkeratosis (raised bumps). The exact cause of LPP is unknown, but it is thought to be an autoimmune condition and is a variant of lichen planus that specifically targets hair follicles.

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Key Points

What is lichen planopilaris?

Lichen planopilaris is a condition where an inflammatory process destroys hair follicles, resulting in permanent hair loss. It is one of the primary forms of scarring alopecia and is often accompanied by symptoms like itching and discomfort on the scalp.

Who gets lichen planopilaris?

Lichen planopilaris primarily affects middle-aged women, although it can occur in men and women of all ages. The exact reasons why certain individuals develop LPP are not fully understood, but it may involve genetic and environmental factors.

Clinical features

LPP typically presents with redness, scaling, and follicular hyperkeratosis around hair follicles on the scalp. It can lead to patches of scarring hair loss where the skin may appear smooth and shiny. Sometimes, symptoms can include burning, tenderness, or pain in the affected areas.

Diagnosis and differential diagnosis

Diagnosis of LPP is often made through a combination of clinical examination, dermoscopy, and scalp biopsy. Differential diagnosis includes other forms of scarring alopecia such as discoid lupus erythematosus and folliculitis decalvans.

Impact and complications

Lichen planopilaris can lead to permanent hair loss and significant psychological distress. It is a progressive condition. Early diagnosis and treatment is important to prevent extensive hair loss and minimise emotional impact.

Treatment options for lichen planopilaris

The treatment for lichen planopilaris focuses on reducing inflammation and preventing further hair loss. Topical treatments, including cortisone lotions, retinoids and calcineurin inhibitors, are commonly used to alleviate symptoms. Oral treatments such as hydroxychloroquine, tetracyclines, or other immunosuppressants may be prescribed. Intralesional corticosteroids can be directly injected into the affected areas to reduce inflammation more effectively. It’s also advised to practice gentle hair care and avoid traumatic styling techniques to minimise further damage. While treatment can help manage symptoms and slow the progression of the condition, it’s important to understand that hair regrowth in areas that have already scarred is unlikely.

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