What Is Lichen Planopilaris?

Lichen planopilaris is a condition that causes inflammation in your scalp and hair follicles. It often causes scarring and patches of permanent hair loss.¹

This article will discuss lichen planopilaris to provide a detailed description of the condition. The key information that will be explored includes the types of lichen planopilaris, causes of lichen planopilaris, signs and symptoms, management and treatment, and diagnosis of the condition.

Overview

Lichen planopilaris is a chronic condition characterised by scarring and areas of hair loss, typically occurring on the scalp. It can also lead to scalp discomfort, such as pain, itching, or burning. While the condition tends to become inactive over time, hair loss caused by it is generally irreversible.¹ Although there is no cure for the condition, treatment focuses on preserving the existing hair and managing symptoms.

Similar to lichen planus, the exact cause of lichen planopilaris is unclear, but it is believed to be connected to the underlying factors that contribute to lichen planus. Managing symptoms of lichen planopilaris can involve the use of medications or laser therapy, with the crucial aspect being early intervention and treatment.¹

Types of lichen planopilaris

There are three distinct types of lichen planopilaris:^2,3

• Classic lichen planopilaris: this form results in scarring and the formation of bald patches on the scalp
• Frontal fibrosing alopecia: primarily affecting post-menopausal women; this condition involves the appearance of bald patches and scarring along the hairline near the forehead. Hair loss may also occur in the eyelashes and eyebrows
• Graham Little syndrome (also known as Piccardi-Lassueur-Graham-Little syndrome): this syndrome is characterised by patchy hair loss on the scalp, as well as hair loss in the armpit and pubic areas. Scarring and bald patches can develop on the scalp, and the hair in the armpits and groin may become thin 

Causes of lichen planopilaris

The precise cause of lichen planopilaris is not completely understood by experts. Nevertheless, it seems that the body's immune cells, specifically T-cells, target and damage the hair follicles. These T cells destroy keratinocytes (which make up the hair cells). Due to the involvement of T-cells, many specialists consider lichen planopilaris to be an autoimmune disease. This is likely due to the fact that in autoimmune conditions, the immune system mistakenly attacks healthy tissues or organs.⁴

Signs and symptoms of lichen planopilaris

Lichen planopilaris leads to redness and flaking of the skin surrounding the base of a hair, resulting in the blockage of the hair follicle. This can give the scalp a rough texture, while areas where hair has been destroyed may appear smooth and shiny. Lichen planopilaris typically manifests in patches but can also affect larger areas. It can also affect facial and body hair.⁴

Lichen planopilaris is a variation of lichen planus, a condition characterised by an itchy rash on the arms, legs, and inside the mouth. Lichen planus can also cause nail ridges or splitting. Nearly half of all individuals with lichen planopilaris also experience symptoms of lichen planus.⁴

Symptoms of lichen planopilaris can appear suddenly or gradually, and the following are commonly observed:⁴

• Scalp pain, itching, burning, or tenderness
• The most commonly affected areas are the top of the scalp (the crown and vertex)
• Red, thick, or scaly patches of skin on the scalp
• Noticeable areas of hair loss or scarring

Management and treatment for lichen planopilaris

There are various medications and therapies available to effectively manage the symptoms of lichen planopilaris. Since lichen planopilaris is an inflammatory disorder, most treatment approaches focus on ways to reduce inflammation. The treatment plan may involve the following, depending on the type of lichen planopilaris:⁵

• Antibiotics (tetracycline): these medications combat bacterial infections and help alleviate inflammation
• Corticosteroids: these medications are used to control inflammation, and they can be applied topically (to the skin) or taken in tablet form
• Anti-malarial drugs (hydroxychloroquine): primarily used to treat malaria, these drugs have shown effectiveness in managing certain inflammatory skin conditions
• Retinoids: these compounds assist in regulating skin cell growth and are employed in the treatment of specific skin conditions. They are available in the form of creams or oral medications. These are usually considered only if the first line of treatment does not work.

Diagnosis

Initially, your healthcare professional will examine your scalp and skin and conduct a physical assessment.⁵ They may inquire about your medical history and current medication use. Since lichen planopilaris can resemble other skin conditions, further diagnostic tests may be necessary, including:

• Dermoscopy: your provider utilises a magnifying device equipped with a light source to closely examine areas of hair loss or scarring⁶
• Skin biopsy: this procedure involves the removal of a small sample of your skin for analysis in a laboratory²

FAQs

How can I prevent lichen planopilaris?

Currently, there is no known way to prevent lichen planopilaris. However, skin changes or hair loss should not be ignored - so ensure you talk to your healthcare provider if you observe symptoms. Hair loss and scarring may be prevented with early treatment of lichen planopilaris.

How common is lichen planopilaris?

Scarring alopecia (hair loss caused by scarring) is most commonly caused by lichen planopilaris. Approximately 43% of patients with scarring alopecia have lichen planopilaris.¹ 

Who is at risk of lichen planopilaris?

A person who is 40 to 60 years old and assigned female at birth is most likely to develop lichen planopilaris. However, it can affect adults of any age or sex.²

When should I see a doctor?

If any symptoms of lichen planopilaris become noticeable, contact a primary care doctor. A skilled dermatologist may need to be consulted to ensure the most effective care.

Summary

Lichen planopilaris is a long-term skin condition that affects the scalp area. There is no cure for lichen planopilaris and the outcome of the condition includes hair loss. Early treatment is the most effective way to keep it at bay, and it can be treated with medication provided by a dermatologist. It is most common in women aged 40 or above and is the cause of scarring alopecia. Seeking help from a primary care doctor can help affected individuals get professional and expert help.