Lichen Planopilaris: Symptoms, Causes, Treatment

What are the symptoms of lichen planopilaris?

Lichen planopilaris (LP) is a chronic, inflammatory skin condition that affects the hair follicles, causing a range of symptoms. The symptoms of lichen planopilaris can vary in severity and may include:

1. Hair loss: The most common symptom of LP is hair loss, which can be patchy or widespread. The hair loss is usually permanent and can be extensive, leading to significant scalp balding.
2. Scalp lesions: Red, inflamed, and itchy bumps or patches on the scalp are common symptoms of LP. These lesions can be small and discrete or large and confluent.
3. Scalp tenderness: The scalp can become tender and painful to the touch, making it uncomfortable to wear hats or touch the affected area.
4. Scalp erythema: The scalp may become red and inflamed, leading to a warm, pinkish appearance.
5. Nodules: Small, firm bumps or nodules can develop on the scalp, which can be painful or tender to the touch.
6. Scalp scaling: Flaky scales or crusts may form on the scalp, especially after scratching.
7. Follicular hyperkeratosis: An overgrowth of keratinized cells in the hair follicle can lead to a rough, scaly appearance on the scalp.
8. Itching: Many people with LP experience intense itching on the scalp, which can be severe and disruptive.
9. Redness and swelling: The affected areas may become red, swollen, and inflamed, leading to a warm and tender sensation.
10. Cicatricial alopecia: In some cases, LP can lead to scarring on the scalp, resulting in permanent hair loss and a “nummular” pattern of baldness.

It’s essential to note that not everyone with lichen planopilaris experiences all of these symptoms, and the severity of symptoms can vary from person to person. If you suspect you have lichen planopilaris, it’s crucial to consult a dermatologist for an accurate diagnosis and appropriate treatment.

What are the causes of lichen planopilaris?

The exact causes of lichen planopilaris (LP) are not fully understood, but it is thought to be an autoimmune disorder. Autoimmune disorders occur when the immune system mistakenly attacks healthy cells and tissues in the body. In LP, the immune system attacks the hair follicles, leading to inflammation and damage.

Several factors may contribute to the development of lichen planopilaris, including:

1. Genetics: LP tends to run in families, and genetic predisposition may play a role in the development of the condition.
2. Hormonal changes: Hormonal fluctuations, such as those experienced during pregnancy or menopause, may trigger LP in some individuals.
3. Environmental triggers: Exposure to certain chemicals, heat, or stress may trigger or exacerbate LP.
4. Autoimmune response: The immune system’s attack on hair follicles is thought to be triggered by an abnormal immune response.
5. Other skin conditions: People with other autoimmune skin conditions, such as vitiligo or alopecia areata, may be more likely to develop LP.
6. Stress: Psychological stress can trigger or worsen LP symptoms in some individuals.
7. Immunosuppression: Weakened immunity, such as in people with HIV/AIDS or undergoing immunosuppressive therapy, may increase the risk of developing LP.
8. Age: LP typically affects adults between 30 and 60 years old, with women being more commonly affected than men.
9. Family history: Having a family history of autoimmune disorders or LP may increase the risk of developing the condition.

While these factors may contribute to the development of lichen planopilaris, the exact cause is still unknown, and more research is needed to understand the underlying mechanisms of this condition.

How is the diagnosis of lichen planopilaris made?

Diagnosing lichen planopilaris (LP) typically involves a combination of physical examination, medical history, and laboratory tests. Here’s a step-by-step approach to diagnosing LP:

1. Physical Examination: A dermatologist will conduct a thorough physical examination to assess the extent and severity of the symptoms, including:
   • Hair loss: Patchy or widespread hair loss, scarring, or a “nummular” pattern of baldness.
   • Scalp lesions: Red, inflamed, and itchy bumps or patches on the scalp.
   • Scalp tenderness: Tenderness or pain when touching the scalp.
2. Medical History: The dermatologist will ask questions about:
   • Duration and progression of symptoms
   • Hair loss pattern (e.g., gradual or sudden)
   • Previous medical conditions or allergies
   • Family history of autoimmune disorders or LP
   • Exposure to potential triggers (e.g., chemicals, stress)
3. Dermatoscopy: A handheld instrument called a dermatoscope can be used to examine the scalp and hair follicles more closely. This can help identify characteristic features such as:
   • Miniature follicles (follicular miniaturization)
   • Inflammation and scaling
   • Follicular hyperkeratosis (thickening of the skin)
4. Biopsy: In some cases, a biopsy may be necessary to confirm the diagnosis. This involves removing a small sample of scalp tissue for microscopic examination. A biopsy can help rule out other conditions that may mimic LP, such as folliculitis or pseudofolliculitis.
5. Laboratory Tests: Laboratory tests may be ordered to support the diagnosis and rule out other conditions. These tests may include:
   • Complete Blood Count (CBC) to evaluate for signs of inflammation or infection
   • Serum electrolyte levels to check for electrolyte imbalances
   • Liver function tests (LFTs) to assess liver health
   • Hormone levels (e.g., thyroid-stimulating hormone, follicle-stimulating hormone) to evaluate hormonal imbalances
6. Differential Diagnosis: The dermatologist will consider other conditions that may mimic LP, such as:
   • Alopecia areata
   • Folliculitis
   • Pseudofolliculitis
   • Scarring alopecia
   • Psoriasis

A combination of these diagnostic steps can help confirm the diagnosis of lichen planopilaris. If you suspect you have LP, consult a dermatologist for a proper evaluation and treatment plan.

What is the treatment for lichen planopilaris?

Treatment for lichen planopilaris (LP) aims to reduce inflammation, slow down hair loss, and alleviate symptoms. The approach may vary depending on the severity and extent of the condition, as well as the individual’s overall health. Here are some common treatment options:

1. Topical Corticosteroids: Mild to moderate topical corticosteroids, such as hydrocortisone cream or ointment, can help reduce inflammation and itching.
2. Topical Immunomodulators: Topical immunomodulators like pimecrolimus cream or tacrolimus ointment can help reduce inflammation and slow down hair loss.
3. Antifungal Creams: Antifungal creams like clotrimazole or terbinafine may be used to treat fungal infections that can exacerbate LP.
4. Oral Corticosteroids: In severe cases, oral corticosteroids like prednisone may be prescribed to reduce inflammation and slow down hair loss.
5. Immunosuppressive Agents: Oral immunosuppressive agents like methotrexate, cyclosporine, or mycophenolate mofetil may be used in severe cases to reduce inflammation and slow down hair loss.
6. Platelet-rich Plasma (PRP) Therapy: PRP therapy involves injecting platelet-rich plasma into the scalp to stimulate hair growth and reduce inflammation.
7. Low-Level Laser Therapy (LLLT): LLLT uses low-level laser or light-emitting diodes to stimulate hair growth and reduce inflammation.
8. Phototherapy: Phototherapy with ultraviolet B (UVB) light or narrowband UVB (NB-UVB) can help reduce inflammation and slow down hair loss.
9. Hair Growth Stimulants: Minoxidil (Rogaine) or finasteride (Propecia) may be prescribed to promote hair growth and slow down hair loss.
10. Surgical Treatment: In some cases, surgical treatment may be necessary to remove scarring or repair damaged skin.

It’s essential to note that LP is a chronic condition, and treatment may need to be ongoing for an extended period. A dermatologist will work with you to develop a personalized treatment plan tailored to your specific needs and response to therapy.

Keep in mind that it’s crucial to follow the treatment plan consistently and under the guidance of a dermatologist to achieve the best possible outcomes for your condition.