Lichen planopilaris

The inflammatory scalp illness known as lichen planopilaris is the cause of hair loss that is irreversible. It is believed that this condition is a subtype of lichen planus, which is a common skin condition characterised by the appearance of discrete rashes that are reddish-purple in colour. Lichen planopilaris is the name given to the condition that occurs when Lichen Planus spreads to the scalp and develops bald patches.

It aggravates the condition of the hair follicles, creating inflammation that ultimately results in scarring and a loss of hair. As a result of the inflammation, the hair follicles will frequently appear scaly and reddish in colour. People can be symptomatic, meaning they have discomfort and itching, or they can have no symptoms at all.

Types of lichen planopilaris

There are actually three different kinds of lichen planopilaris. And they include classic lichen planopilaris, frontal fibrosing alopecia, and the Graham little syndrome.

Classic Lichen Planopilaris

The most common manifestation of lichen planopilaris is a patch that appears on the scalp. This skin disorder is linked to inflammation of the hair follicles. Which can result in scarring as well as irreversible hair loss.

Frontal Fibrosing Alopecia

This type of LPP is distinguished by a pattern of gradual hair loss that takes place over time and can lead to scarring in the area near the forehead. There is a possibility that the condition could also affect the eyelashes and eyebrows.

Lassueur Graham-Little Piccardi Syndrome

The presence of cicatricial alopecia on the scalp. Which leads in permanent hair loss, and non-scarring alopecia on other regions of the body are the defining characteristics of Graham Little Syndrome. This particular variety of LPP is more likely to affect women. And its symptoms include spotty scarring hair loss, thinning hair in the armpit and groyne areas. And rough lumps around the hair follicles.

Who gets Lichen Planopilaris and why?

The lichen planopilaris can affect people of any age, but it is most common in young men and women. Children and the elderly are less likely to be affected. On the other hand, the majority of those who are afflicted are females between the ages of 40 and 60. This condition frequently develops in tandem with lichen planus, a disease that impacts the mucosal membranes of the skin, nails, and other parts of the body. Lichen Planus develops in approximately fifty percent of patients who have Lichen Planopilaris. Although this condition is not passed down from parent to child. There are specific genes that put a person at a greater risk of developing this disease than others.

What Causes Lichen Planopilaris?

Since the actual aetiology of lichen planopilaris is unknown, treating it might be difficult. As a result, the condition is difficult to diagnose. There are certain clues and hypotheses that point to autoimmunity as the root cause of this illness. When this happens, the immune system of the body overreacts and assaults healthy tissues in the body instead of the pathogen it is supposed to be protecting against. In this particular instance, the cells of the immune system known as lymphocytes launch an assault on the hair follicles and eradicate the stem cells.

Because of this, the hair will fall out, and a scar will be produced. The hypothesis that is regarded to be most accurate is that white blood cells are responsible for destroying skin and hair cells. In most cases, the diagnosis of LPP is reached through a combination of a physical examination and a microscopic analysis of a small amount of afflicted tissue obtained using a punch biopsy.

In addition, a number of environmental factors have the potential to set off an inappropriate immune response. Which ultimately leads to inflammation of the hair follicles and hair loss. This form of hair loss is typically irreversible and permanent. And there is not a lot of room for the hair to grow back after it has been lost. A person’s likelihood of having this condition is increased by the presence of specific gene variants.

What Are the Symptoms of Lichen Planopilaris?

Those affected by Lichen Planopilaris might experience a wide range of symptoms, depending on their specific case. The vertex and crown region are the most heavily impacted areas. Hair loss and the appearance of bald patches are two symptoms that are easy to spot. Additionally, scaling can be seen moving outward from the lesions.

Pain and itching are the most prominent symptoms that patients experience. And these are often accompanied by redness and a degree of discomfort. Patients who are afflicted with this condition frequently exhibit signs of lichen planus. A condition that impacts the skin as well as the mucous membranes of the body. These are the symptoms that are observed most frequently:

  • Loss of hair in bald spots
  • A ruddy appearance of the scalp
  • Ache in the scalp
  • A rash or itching on the scalp

What are Treatment Options for Lichen Planopilaris?

The ideal time to start treating LPP is as soon as possible. The earlier you start treating LPP because hair loss is permanent, the less hair loss you might experience in the future. Stopping hair loss and managing symptoms are the goals of treatment. Patients with lichen planopilaris frequently receive anti-inflammatory medicine prescriptions. An expert in medicine might advise you to take one of the following if you have LPP:

  • Topical corticosteroids
  • Corticosteroid injections
  • Oral corticosteroids
  • Anti-malarial medication like hydroxychloroquine
  • Retinoids


This is a topical medication that your healthcare professional may also prescribe in order to boost hair growth in hair follicles that have not been impacted by the condition. It is believed that minoxidil works by encouraging the hair follicle to enter the anagen (growth) phase, despite the fact that the exact mechanism by which it operates is unknown. There are two different strengths of minoxidil available: a 2% concentration and a 5% variant. Neither formulation of minoxidil needs a doctor’s prescription to be purchased.

Risk factors of Lichen Planopilaris

Age is one of the risk factors for lichen planopilaris, and the majority of people who have this disease are women in the middle years of their lives. People who inherit a certain set of genes are more likely to develop Lichen Planopilaris. It has been found that adults of the Caucasian race have a higher prevalence of this condition compared to individuals of other populations.

People who have had an infection with hepatitis C are more likely to acquire this condition. The development of this condition can also be brought on by exposure to environmental factors, such as certain medications and chemicals. It has also been shown that a particular type of damage to the scalp might result in this condition.

Where to Start If LPP Happens to You

It is imperative that you consult a medical expert as soon as possible if you have any reason to believe that you may be suffering from this form of follicular lichen planus. This will allow you to discuss the many treatment options available to you for your hair loss. This will assist you in reducing the appearance of bald spots to the greatest extent possible.

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