Introduction:

Alopecia, or hair loss, can manifest as a complication of lichen planus, a chronic inflammatory skin condition that affects the skin, mucous membranes, and hair follicles. While lichen planus primarily presents with distinctive skin lesions, its association with alopecia can significantly impact affected individuals. This article explores the relationship between lichen planus and alopecia, elucidating the clinical features, underlying mechanisms, and management strategies for this dermatological manifestation.

Clinical Features:

• Scarring Alopecia: Lichen planopilaris (LPP) is a variant of lichen planus that specifically involves the scalp and hair follicles, resulting in scarring alopecia. It presents with characteristic lesions, including erythematous papules, follicular plugging, and perifollicular erythema.
• Progressive Hair Loss: LPP typically presents with gradual hair thinning, patchy hair loss, and the formation of smooth, shiny areas of scalp devoid of hair follicles. Over time, affected areas may progress to irreversible scarring and permanent hair loss.
• Symptoms: Patients with alopecia secondary to lichen planus may experience itching, burning, or tenderness of the scalp, often preceding the onset of visible hair loss. These symptoms can significantly impact quality of life and contribute to psychological distress.

Underlying Mechanisms:

• Autoimmune Response: Lichen planus is characterized by an aberrant immune response directed against the skin and hair follicles. T-cell-mediated inflammation and destruction of hair follicles contribute to the development of scarring alopecia in LPP.
• Cytokine Imbalance: Dysregulation of cytokine signaling pathways, particularly interleukin-2 (IL-2), interferon-gamma (IFN-gamma), and tumor necrosis factor-alpha (TNF-alpha), plays a role in the pathogenesis of lichen planus and associated alopecia.
• Genetic Predisposition: Genetic factors may influence susceptibility to lichen planus and its complications, including alopecia. Family history of autoimmune conditions or lichen planus may increase the risk of developing LPP.

Management Strategies:

• Topical Treatments: High-potency topical corticosteroids are commonly used as first-line therapy for LPP to reduce inflammation and halt disease progression. Tacrolimus ointment or topical calcineurin inhibitors may be considered as alternative options.
• Intralesional Steroid Injections: In cases of localized or refractory LPP, intralesional corticosteroid injections directly into affected areas of the scalp can provide targeted anti-inflammatory effects and promote hair regrowth.
• Systemic Therapy: Oral corticosteroids, immunomodulatory agents (e.g., hydroxychloroquine, methotrexate), and systemic retinoids (e.g., acitretin) may be prescribed for widespread or severe cases of LPP to suppress immune-mediated inflammation and preserve remaining hair follicles.
• Adjunctive Therapies: Adjunctive therapies, such as phototherapy (e.g., narrowband UVB), topical minoxidil, and platelet-rich plasma (PRP) injections, may be considered to enhance hair regrowth and improve cosmetic outcomes in select cases.

Conclusion:

Alopecia associated with lichen planus, particularly lichen planopilaris, poses a significant clinical challenge due to its potential for irreversible scarring and permanent hair loss. By understanding the clinical features, underlying mechanisms, and management strategies for alopecia in lichen planus, dermatologists and healthcare providers can effectively diagnose, treat, and support individuals affected by this dermatological complication.

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