lichen planopilaris (lichen planus)

Last reviewed 01/2018

Lichen planopilaris (LPP)

This is a form of lichen planus

• is an uncommon, chronic scarring alopecia most commonly seen in Caucasian and East Indian females (female to male ratio 1.8:1), the majority being adults between 25 and 70
• may occur alone or with other forms of LP. Scalp lesions can be single or multiple, focal or extensive and usually located over the vertex and parietal area
• clinical appearance is of whitish atrophic patches on the scalp with loss of follicular orifice. There is follicular hyperkeratosis and perifollicular erythema. Positive pull test of anagen hairs indicate active lesions
  • symptoms include those of increased hair shedding, itching, scaling, burning, tenderness, and uncommonly scalp ulceration
  • types include:
    • 1. Classic LPP; affecting scalp hair and sometimes extracranial LP
    • 2. Fibrosing frontal alopecia (FFA); a progressive band-like scarring alopecia of the frontal hairline, affecting middle-aged women
    • 3. Graham Little Syndrome; a triad of scarring alopecia of the scalp, lichen planus of the skin with widespread follicular papules and nonscarring hair-loss of axillary and pubic hair.

Management options depend on age and symptoms (disease severity) and extent of scalp involvement

• topical glucocorticoids, either alone or combined with intralesional glucocorticoid injection form the mainstay of treatment
• systemic glucocorticoids are used in severe or resistant cases
• hydroxychloroquinine can be used in severe or resistant cases
• immunomodulating agents e.g. cyclosporine and mycophenolate mofetil have been advocated for uncontrollable LPP. Other third-line therapies include systemic retinoids, tetracycline, griseofulvin, thalidomide, dapsone, topical tacrolimus, and minoxidil
• hair transplantation and/or scalp reduction can be considered if active inflammation has not been present and the hair pull test is negative for more than 2 years

Contributor: Dr Maryanne Hammon (GP; 23/3/2014)

Reference:

• Kang H, Alzlibani A, Otberg N, Shapiro J. Lichen planopilaris. Dermatologic Therapy 2008;21:249-256.