What are the other Names for this Condition? (Also known as/Synonyms)

• Follicular Lichen Planus
• Lichen Follicularis
• Lichen Planus Follicularis

What is Lichen Planopilaris? (Definition/Background Information)

• Lichen Planopilaris (LPP) is a subtype of lichen planus primarily involving the scalp. This inflammatory condition is characterized by hair loss in patches on the scalp along-with pain, irritation, and discomfort
• Based on the pattern of hair loss and symptom types, the following variants of Lichen Planopilaris are described:
  • Classic Lichen Planopilaris
  • Frontal fibrosing alopecia (FFA)
  • Lassueur Graham-Little Piccardi syndrome
• Some research experts believe that Lichen Planopilaris may be an autoimmune disorder of unknown cause. The condition may be triggered by factors such as metals, viral infection, certain medications, or procedures
• The management of Lichen Planopilaris may involve topical agents, steroids, and systemic therapy. Even though some cases are known to resolve spontaneously. In some individuals, the condition may progress rapidly and cause permanent hair loss

Who gets Lichen Planopilaris? (Age and Sex Distribution)

• Lichen Planopilaris is an uncommon inflammatory condition of the skin
• The presentation of symptoms is mostly noted in the early stages of adulthood. However, it may affect individuals of a wide age range
• Although both genders may be affected, the condition occurs more frequently in women 
• Worldwide, individuals of all racial and ethnic groups may be affected

What are the Risk Factors for Lichen Planopilaris? (Predisposing Factors)

The risk factors for the development of Lichen Planopilaris may include:

• Some pigments and metals
• Use of non-steroidal anti-inflammatory medication (NSAIDs) such as ibuprofen and naproxen
• Flu vaccine
• Some medications for high blood pressure
• Medications for arthritis
• Hepatitis C virus infection 
• Medical procedures such as hair transplantation or facelift

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Lichen Planopilaris? (Etiology)

The exact cause of Lichen Planopilaris is not clearly understood, but it may be an autoimmune disorder. It is reported that exposure to certain chemicals, metals, or infections may act as triggers for the development of the condition. Such factors may include:

• Certain pigments and metals
• Infections, such as those caused by hepatitis C virus
• A variety of medications, such as used for pain (including NSAIDs), to lower blood pressure, and arthritis, among others

What are the Signs and Symptoms of Lichen Planopilaris?

The signs and symptoms of Lichen Planopilaris may vary from one individual to another. The condition progresses slowly, and the signs and symptoms may include:

• Appearance of hairless patches on the scalp; these may be localized and small but can increase in size when several focal areas merge
• The patches are shiny and occur in the areas of hair loss (alopecia)
• The hairs may be easily ‘pulled out’
• Redness and scale formation in tight contact with the follicle can be present; these may be spiny to touch
• The common areas presenting hair loss are the front, sides, and posterior region on the scalp (occipital)
• In some cases, pain, itching, and discomfort may be noted
• At the site of hair loss, there may be burning sensations and tenderness
• Nail abnormalities and skin blistering may be noted

How is Lichen Planopilaris Diagnosed?

Lichen Planopilaris is diagnosed on the basis of the following information:

• Physical examination of the individual and medical history evaluation
• Assessment of symptoms and visual inspection of the affected region
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Trichoscopy or hair scalp evaluation
• Skin biopsy is usually necessary: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed), and microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Lichen Planopilaris?

The complications of Lichen Planopilaris may include:

• Permanent hair loss (balding)
• Low self-esteem because of one’s appearance
• Shiny and very smooth scalp from the absence of small open follicles 
• Severe pain and discomfort in the pubic area if the genitals are affected
• Recurrence of the condition following treatment

Complications may occur with or without treatment and in some cases, due to treatment.

How is Lichen Planopilaris Treated?

Presently, there is no cure for Lichen Planopilaris. The treatment measures are often tailored towards reducing the signs and symptoms. The following measures may be used:

• Ointments containing steroids (which may be of moderate or high potency)
• Steroid injections into skin lesions if topical medication is ineffective
• Systemic corticosteroids if topical medication is ineffective
• Hydroxychloroquine and Rituximab (immune-suppressing medication)
• Retinoids
• Oral cyclosporine (immunosuppressant medication)
• Methotrexate (generally used for psoriasis)
• Phototherapy with ultraviolet B wavelength light
• Mycophenolate mofetil (immune-suppressing medication)
• Pioglitazone (medication used for diabetes)
• For severe cases, hair transplantation may be considered

Regular medical screening at periodic intervals with tests and physical examinations is recommended.

How can Lichen Planopilaris be Prevented?

Lichen Planopilaris may be preventable, or the signs and symptoms minimized if the triggers for the condition are identified and controlled.

• Undertaking prompt treatment for hepatitis C virus (HCV) infection is important
• Avoid exposure to causative pigments and metals
• Discontinuing the offending medication causing the condition

What is the Prognosis of Lichen Planopilaris? (Outcomes/Resolutions)

The prognosis of Lichen Planopilaris depends on the severity of the signs and symptoms and associated complications, as well as the progression of the condition.

• Some cases of Lichen Planopilaris may resolve on their own and lead to good outcomes
• On the other hand, rapidly progressing and/or severe signs and symptoms may take longer to resolve, causing pain, discomfort, and significant distress to the affected individuals
• In some instances, the condition may even recur after successful treatment

Additional and Relevant Useful Information for Lichen Planopilaris:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/