Lichen Planopilaris (Scarring Alopecia)

What is Lichen Planopilaris?

Lichen Planopilaris is a form of scarring alopecia, which usually affects younger women, although can affect most age ranges and more rarely, men. Primary scarring alopecias are conditions in which the immune system attacks the stem cells that keep the hair follicle alive. This destroys the hair follicle and replaces it with scar tissue. Although Lichen Planopilaris is a rare condition, it is one of the most common causes of scarring hair loss of the scalp.

People with Lichen Planopilaris may also have Lichen Planus, a condition which affects the skin, mucosa and nails (click here for more information about Lichen Planus).

What does Lichen Planopilaris look like?

Lichen Planopilaris causes smooth, shiny patches of scalp hair loss. No hair follicle openings can be seen in the areas of hair loss. At the edges of these patches, there may be scaliness and redness around the base of each hair, which can make it feel rough. Hairs can be easily pulled out. Lichen Planopilaris often occurs in multiple areas of the scalp, which can join as the condition progresses. The most common areas for Lichen Planopilaris to occur are the sides, front and lower back of the scalp. More diffuse hair loss is uncommon.

People do not always have any symptoms of Lichen Planopilaris, but they may experience:

Itch
Pain
Tenderness
Discomfort
Burning

How is Lichen Planopilaris diagnosed?

Lichen Planopilaris is usually diagnosed using a combination of trichoscopy (examining the hair and scalp using a microscope) often accompanied by a scalp biopsy to confirm the diagnosis. However, it can be difficult to diagnose Lichen Planopilaris and in some cases the diagnosis may not be able to be confirmed

Is Lichen Planopilaris permanent?

Yes, in this condition, the hair follicles are destroyed and turned into scar tissue. Lichen Planopilaris is a slowly progressive condition, which means that the areas of the scalp that are affected by the condition will slowly increase over time.

What causes Lichen Planopilaris?

The cause of Lichen Planopilaris is unknown although it is not believed to be hereditary. The trigger is not yet known but it could involve infection, medications or chemicals that are in contact with the skin.

Can Lichen Planopilaris be treated?

The hair loss caused by Lichen Planopilaris cannot be reversed, however, progression of the condition can be limited in some people. Treatments used to slow the progression of the condition include anti-inflammatory agents, including corticosteroids, ciclosporin and hydroxychloroquine. Some recent reports have also shown success using JAK-inhibitors to treat Lichen Planopilaris in a small number of patients.

Additional Information:

The British Association of Dermatologists have produced a patient information leaflet about Lichen Planopilaris:

CLICK HERE FOR THE BAD PATIENT INFORMATION LEAFLET ON LICHEN PLANOPILARIS

The British Hair and Nail Society also provide some useful information about the condition:

CLICK HERE FOR THE BHNS LEAFLET

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