Lichen planopilaris - Hair and Scalp
The condition may have an insidious or fulminant onset with hair loss in variable patterns. There are several variants of LPP: classic LPP, frontal fibrosing alopecia, and Graham-Little-Piccardi-Lassueur (Graham-Little) syndrome. Classic LPP presents with follicular violaceous erythema and perifollicular fine scale. Interfollicular erythema may also be seen, and in severe cases, confluent scale may be evident. The perifollicular erythema is usually seen at the periphery of patches of alopecia, which corresponds to active areas of disease. As the disease progresses, permanent cicatricial alopecia or Brocq alopecia occurs. Frontal fibrosing alopecia, as the name implies, clinically appears as a band-like scarring alopecia of the frontal hairline that commonly affects women. Graham-Little syndrome consists of the triad of cicatricial alopecia of the scalp, a lichenoid follicular eruption, and noncicatricial pubic and axillary hair loss. In addition, a diffuse variant was recently described. It presents with diffuse scalp itching with widespread hair thinning and erythema. This variant has no predilection by sex.
Increased hair shedding, severe itching, scaling, burning, and tenderness are common symptoms associated with LPP.
Related topics: oral lichen planus, lichenoid drug eruption
L66.1 – Lichen planopilaris
64540004 – Lichen planopilaris
Differential Diagnosis & Pitfalls
- Seborrheic dermatitis – Scaling with erythema of the scalp can be confused with early LPP before alopecia occurs.
- Discoid lupus erythematosus – Scarring patches of alopecia with inflammation; erythema not confined to perifollicular areas. Dyspigmentation is more commonly seen.
- Central centrifugal cicatricial alopecia – Scarring alopecia of the vertex of the scalp expanding centrifugally, usually in Black women.
- Alopecia areata – Nonscarring circular patches of alopecia with little or no inflammation. Exclamation-point hairs and yellow dots on dermoscopy can help aid in diagnosis.
- Trichotillomania – Nonscarring patches of alopecia with angulated, irregular borders. Broken hairs of different lengths are seen.