Lichen Planopilaris (LPP)

The fungus known as lichen planopilaris (LPP) can infect the scalp and the hair. It is a subtype of lichen planus, an inflammatory condition that can affect the skin and mucous membranes. Scaly patches and redness surrounding hair follicles are two possible symptoms. in addition to presenting bald spots and pain, blistering, or irritation on the scalp.


What Signs and Symptoms Are Associated with Lichen Planopilaris?

In most cases, lichen planopilaris manifests on the scalp as a patchy hair loss. There may be scaling surrounding the individual hair follicles, and the areas may be red or inflammatory. Patients may report a searing pain or discomfort in these locations as their primary complaint. Because the follicular apertures have been closed off, the areas where hair has been lost may have a shiny and smooth appearance.


Although thinning of the scalp hair is the most prevalent symptom, other areas of the body, such as body hair and eyebrows, may also be affected. You may notice several tiny red pimples called papules around the clusters of hair. Scarring can result from LLP, leading to irreversible hair loss (cicatricial alopecia).



There is no definitive information regarding the frequency of the various cicatricial alopecias. Nevertheless, in a group of 72 patients, researchers found the condition known as lichen planopilaris. Is the most common cause of primary scarring alopecia. This condition affected 43 percent of the patients.

What Are the Factors That Lead to Lichen Planopilaris?

It is not known what causes lichen planopilaris. However, it is recognized to be an inflammatory disorder of the skin that is not connected with an infection.


Who Should Be Concerned About Getting Lichen Planopilaris?

Lichen planopilaris is more frequent in women than in men. The majority of those who are affected are middle-aged or elderly Caucasian women.


How Is Lichen Planopilaris Diagnosed?

It is critical to get a diagnosis as soon as possible to assist slow or stopping the disease’s progression. Because there may be other hair loss disorders present. Should also be treated with aa dermatologist who mainly focuses on hair thinning and scalp conditions. That also seeks to determine all of the conditions responsible for the patient’s hair loss and treat them accordingly.


The diagnosis may entail a physical examination using a dermatascope, blood testing to rule out any underlying medical disorders, hair pull tests, and in some instances, a biopsy of the scalp. The skin biopsy will be evaluated by a specialized pathologist with previous expertise with hair loss and disorders affecting the scalp. Typically, the doctor will obtain two to three samples from the scarring regions.


Treatment For Planopilar Lichen

Lichen Planopilaris


Treatment should begin as soon as possible because this disorder might cause permanent hair loss. Managing this ailment can be challenging, and not all individuals respond favorably to medication. The ability to regrow hair is not the primary objective of the therapy; instead, the goal is to stop the development of hair loss.


Systemic therapy can also be utilized, including hydroxychloroquine, antibiotics from the tetracycline group due to their anti-inflammatory properties, and other immunosuppressant drugs in some cases. Because of the potential for adverse reactions, patients undergoing treatment for lichen planopilaris with systemic medicines need to be closely monitored in the clinical setting.


Background And Physiological

In patients with lichen planopilaris, the appearance of hair loss can be highly diverse, and the clinical phase of hair loss can range from gradual to severe hair loss.


There is also a possibility of experiencing a hair loss pattern reminiscent of Brocq’s alopecia and central centrifugal alopecia. The lesions on the scalp can be single or many, localized or diffuse, and they can appear in any location on the scalp. In cases of cicatricial alopecia, a pull test may reveal anagen hair, a vital marker of an operational condition that needs treatment.


Extreme manifestations of symptoms like itching, burning, discomfort, and soreness are common. Nail, cutaneous, and mucous membrane lichen planus can appear before, during, or following the initial invasion of the scalp.


The perifollicular scaling seen in active lichen planopilaris is the trichoscopic feature that most distinguishes it from other forms of the condition. Trichoscopy of dormant end-stage lichen planopilaris displays small, oddly shaped, white patches that lack follicular openings. These areas are referred to as “fibrotic white dots,” White regions of conducted fibrosis accompany them.



The treatment seeks to lessen the amount of hair loss, bring symptoms under control, and halt the scarring process. Therapy is determined by the patient’s perceived severity level and capacity to tolerate the treatment because there are no reliable markers to evaluate the progression of the condition.


The clinical response and recurrence rates should be used as a reference to determine the length of treatment. Avoiding physical or chemical damage to the hair is one of the general precautions that you should take. It is a common misconception among patients that the number of times they shampoo their hair affects the overall quantity of hair that is shed, but this is not the case.


Topical tacrolimus and potent corticosteroids are frequently considered first-line therapy. For all forms of basic cicatricial alopecia and are regularly utilized in treating the condition. Antimalarial medication is commonly used in the treatment of lichen planopilaris.


The standard dose, hydroxychloroquine 200 mg twice daily, is frequently considered the initial course of treatment for systemic infections. Minoxidil helps to make the most of the hair growth potential of the follicles that are still there. In most cases, the improvement is visible within the first six months. It has been suggested to use a new scoring system called the lichen planopilaris activity index to document the condition’s progression and the response to treatment.


It does this by assigning numeric values to the objective and subjective indicators of the disease. Like the symptoms and signs, assessment, and the extent of the condition. Its goal is to make it possible to perform statistical comparisons of responses obtained before and after therapy.



To verify the importance of these findings. Additional research that is both wider in scope and investigates LPP in a more extensive population is required. Clinicians need to understand the significance of the comorbidity account of patients who have LPP. To have a deeper comprehension of the potential pathogenic pattern. And to be able to maximize the effectiveness of the lab work up.



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