Lichen Planopilaris

Lichen planopilaris

Description, Causes and Risk Factors:

Abbreviation: LPP.

A rare, patchy alopecia with follicular hyperkeratosis of the scalp and lymphocytic perifolliculitis with lichen planus elsewhere.

Lichen planopilaris is a type of scarring hair loss that is thought to a variant of lichen planus attacking hair bearing areas. Inflammation around the hair follicle causes destruction of the follicle, which is then replaced with scar tissue. It is twice as common in woman as it is in men and seen mostly in adults, with the commonest age of onset being in the mid-40s.

Lichen planopilaris causes redness around the hair follicle, as well as some scale around the hair, known as follicular hyperkeratosis. This may give the base of the hairs a rough feel. Where hairs have been destroyed the scalp is shiny pink. The crown and vertex are most commonly affected and Lichen planopilaris is typically diffuse in its distribution.

Lichen planopilaris can be subdivided into 3 variants: classic LPP, frontal fibrosing alopecia (FFA), and Lassueur Graham-Little Piccardi syndrome. With the exception of FFA, the hairless patches of the scalp can be unique or can occur in multiples and can present with a reticular pattern or as large areas of scarring.

You can set off this condition when you expose yourself to certain chemicals or if you have allergic reactions to certain types of medications. However, how it is triggered is still quite unknown. Some of the types of medication that can trigger this condition are antimalarial agents, penicillin, beta blockers, anti inflammatory drugs, and gold. It usually takes weeks or years after your exposure to some of these medications before symptoms appear.

If you are having chronic Hepatitis C, it might bring this disease up. People with weak immune system have much higher chance of contracting this disease.


Lichen planopilaris typically causes an intensely itchy scalp. The crown andvertex are most typically affected. The itch is associated with hair loss. Painburning and scalp tenderness may also be experienced.Perifollicular erythema, scales, and/or keratotic plugs are seen at the edge of the affected area. Single or multiple lesions of scarring alopecia lacking follicular orifices are typical.

You might notice papules, which are small, elevated areas on the skin (like pimples). The characteristics of the papules are redish purple or white and shiny, flat surface on the elevated areas, unevenly shaped, and itchiness.


Differential diagnosis may include DLE (discoid lupus erythematosus), folliculitis decalvans, mucous membrane pemphigoid, seborrheic dermatitis, alopecia areata, and CCCA (central centrifugal cicatricial alopecia).

Diagnosis is based on clinical and histopathological findings. Biopsy of an inflammatory lesion shows a band-like perifollicular lymphocytic infiltrate at the level of the isthmus and infundibulum. There may be vacuolar changes of the basal layer and follicular plugging. In more advanced lesions, perifollicular fibrosis and replacement of hair follicles by fibrosis are found. Diagnosis is difficult in the later stages when inflammation disappears.


You should seek immediate treatment as quickly as possible to avoid permanent hair loss. Treatment differs on case to case because severity of symptoms, extent of the papules, and response to treatment vary. Usually your doctor might try to look for any drugs or medication that you are taking that can reflects this disease. Stopping such medications can stop this condition.

Treatment Options May Include:

    Lichen planopilaris can be treated with topical treatments, such as steroid lotions and tablets. The evidence for any of the treatments in this condition is poor.

  • Topical Steroids: Localized disease can be managed by potent topical steroids in the form of lotions, gels or mousses. Injection of a steroid may be an option if only a small area is involved.

  • Systemic Steroids: Short courses of oral steroids can be used to try and switch off the attack, but side effects limit the long term use of oral steroids.

  • Antihistamines to relieve moderate itching.

  • Hydroxychloroquine: Although slow to act, this member of the anti-malarial family can be very useful in this condition.

  • Tetracycline antibiotics: These antibiotics are commonly used in the treatment of acne. They are occasionally used to treat lichen planopilaris.

  • Mycophenolate mofetil: This is a powerful immunosuppressive drug most commonly used in patients who have had a kidney transplant.

This disease usually resolves without treatment, but can recur years later. What you need to do is to constantly monitor this disease and seek medical therapy to make sure this condition does not reoccur.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

Reference and Source are from:

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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