Lichen planopilaris (LPP) is an inflammatory scalp condition that leads to patchy scarring hair loss . LPP overlaps with other syndromes and conditions such as the previously-discussed Frontal fibrosing alopecia (FFA article) and Graham Little syndrome which is characterized by progressive scarring hair loss on the scalp, non-scarring hair loss in the underarm and groin, and spiky bumps located over hair follicles. LPP can also overlap with lichen planus, a similar inflammatory process that affects the skin on the body and develops purplish, flat, itchy bumps called lichen planus.
LPP affects woman more often than men. The FFA type affects primarily postmenopausal women while the Graham Little Syndrome affects primarily Caucasian women between ages 30-60 years1. There are studies looking at the correlation between LPP and thyroid disorders but further information is needed to make a definite link between the two conditions2.
The early stage of LPP typically presents as scaling or red bumps around each follicle on the frontal and crown of the scalp. Other symptoms experienced include tenderness, burning, and itching. As the condition progresses the inflammatory process starts destroying follicles, leaving behind scarred, white, patches of hair loss. Initially these patches may be small and diffuse but can spread wider and become connected with more severe disease.
Diagnosis is through an examination and sometimes biopsy. The scalp is assessed for scaling and redness around the follicels, the hairs are pulled to see if they remove easily. Trichoscopy (trichology) is used to assess if the follicles are present and to assess the root of the hair to determine which phase the hair is in (life cycle of hair). A full body exam is also performed to assess for lichen planus lesions on the skin, in the mouth, genitals, or nails. A biopsy can be helpful to assess for deeper inflammation of the scalp and show if activity is present or absent.
Treatment aims at reducing the inflammatory process. Topical steroids and non-steroidal agents are used at home. In-office steroid injections can help calm down inflammation at the site without the side effects of taking an oral steroid and can penetrate deeper than topical steroids. Oral medications are usually initiated for more advanced disease to help reduce inflammation. Close follow up is warranted to assess for symptoms and monitor for slowing and halting the progression of the condition.
- LászlóFG. Graham-Little-Piccardi-Lasseur syndrome: case report and review of the syndrome in men. Int J Dermatol. 2014;53(8):1019.
- Atanaskova Mesinkovska N, Brankov N, Piliang M et al. Association of lichen planopilaris with thyroid disease: a retrospective case-control study. Kyei A, Bergfeld WF. J Am Acad Dermatol. 2014;70(5):889.