Lichen Planopilaris: Symptoms, Causes, Diagnosis and Treatment

Written by Medicover Team and Medically Reviewed by Dr Saily Shejol , Dermatologists

Lichen Planopilaris is a rare inflammatory condition that affects the hair follicles, most commonly on the scalp. It is considered a form of lichen planus and can lead to progressive scarring, hair loss, itching, and scalp discomfort. The condition occurs when the immune system mistakenly attacks the hair follicles, resulting in permanent damage if left untreated. Early diagnosis and appropriate treatment are important to slow disease progression and preserve remaining hair.

What are the Types of Lichen Planopilaris?

Lichen planopilaris can present in various forms, each with distinct characteristics. Understanding these types is essential for accurate diagnosis and treatment.

Classic Lichen Planopilaris

Classic LPP is the most common form and primarily affects the scalp. It presents with symptoms such as itching, redness, and scaling, eventually leading to scarring and hair loss.

Frontal Fibrosing Alopecia (FFA)

Frontal fibrosing alopecia is a variant of LPP that affects the frontal hairline, eyebrows, and sometimes the body hair. It is more commonly seen in postmenopausal women and is characterized by a receding hairline and perifollicular erythema (redness around hair follicles).

Graham-Little-Piccardi-Lasseur Syndrome

This rare variant involves a triad of symptoms: scarring alopecia of the scalp, non-scarring alopecia of the body, and lichenoid follicular papules. It is a more severe form and requires aggressive treatment.

What are the Symptoms of Lichen Planopilaris?

Early Symptoms

Early lichen planopilaris symptoms can be subtle, making early diagnosis challenging. Initial signs include itching, burning, or tenderness of the scalp. Patients may also notice redness and scaling around hair follicles.

Progressive Symptoms

As the condition progresses, hair loss becomes more apparent. The affected areas may show signs of scarring, and the scalp can develop a shiny appearance due to the loss of hair follicles. In some cases, the eyebrows and body hair may also be affected.

What are the Causes of Lichen Planopilaris?

Autoimmune Connection

The precise cause of lichen planopilaris remains unknown. However, it is widely believed to be an autoimmune disorder. In autoimmune diseases, the body's immune system mistakenly attacks healthy cells. In the case of LPP, the immune system targets hair follicles, leading to inflammation and scarring.

Genetic Predisposition

Some studies suggest a genetic predisposition to developing LPP, although the exact genetic factors involved are not fully understood. Family history can sometimes play a role, indicating that certain genetic markers might increase susceptibility to the condition.

Environmental Triggers

Environmental factors may also contribute to the onset of LPP. These could include stress, infections, or exposure to certain chemicals. However, more research is needed to fully understand the environmental triggers that may precipitate this condition.

When to See a Doctor for Lichen Planopilaris?

Persistent hair loss, scalp itching, redness, burning sensations, or patchy bald areas should be evaluated by a Dermatologist or Hair Loss Specialist. Early treatment can help preserve remaining hair and reduce scarring.

You should see a doctor if you experience:

Seek prompt medical attention if:

These symptoms may indicate active follicular destruction requiring urgent treatment.

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How is Lichen Planopilaris Diagnosed?

Clinical Examination

A thorough clinical examination by a dermatologist is the first step in diagnosing LPP. The dermatologist will look for characteristic signs such as perifollicular erythema, scaling, and scarring.

Biopsy

A scalp biopsy is often necessary to confirm the diagnosis. This involves taking a small sample of the scalp tissue and examining it under a microscope. The biopsy can reveal inflammation around hair follicles and the presence of scarring, which are indicative of LPP.

Trichoscopy

Trichoscopy, a non-invasive imaging technique, can be used to examine the scalp in detail. This method helps visualize the hair follicles and identify specific patterns associated with LPP, aiding in the diagnosis.

What are the Treatment Options for Lichen Planopilaris

Topical Treatments

Topical corticosteroids are commonly prescribed to reduce inflammation and alleviate symptoms. These are applied directly to the affected areas of the scalp. Other topical treatments include calcineurin inhibitors, which also help modulate the immune response.

Oral Medications

Oral medications are often necessary for more severe cases. These can include:

Intralesional Injections

Intralesional corticosteroid injections involve injecting steroids directly into the affected areas of the scalp. This method can be effective in reducing inflammation and slowing the progression of hair loss.

Light Therapy

Phototherapy, or light therapy, involves exposing the scalp to specific wavelengths of light. This treatment can help reduce inflammation and is sometimes used in conjunction with other therapies.

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What is the Recovery Process for Lichen Planopilaris?

Lichen Planopilaris is a chronic condition that may require ongoing treatment and monitoring. The primary goal is to stop disease progression and preserve existing hair, as scarring-related hair loss is usually permanent.

Regular follow-up helps assess disease activity and treatment effectiveness.

Recovery Includes