Lichen Planopilaris

Lichen Planopilaris (LPP) is lichen planus (see lichen planus discussion) involving the hair follicles. Most cases of LPP involve the scalp and cause a scarring hair loss. Nearly 70-80% of patients are women 40-50 years of age. A skin biopsy is necessary to make an appropriate diagnosis.

Lichen planopilaris can also be seen in patients with Graham-Little-Piccardi syndrome, characterized by LPP of the scalp with keratosis pilaris-like lesions (see keratosis pilaris discussion) as well as hair loss of the eyebrows, under-arms, and pubic area.

LPP presents with redness surrounding the hair follicles and eventually progresses to scarring hair loss. Small, red, raised bumps may be seen around the hair follicles. Lesions may occur on the chest, abdomen, back, or extremities. In most patients, only the scalp is affected. Once LPP progresses to scarring, the scalp will demonstrate areas of hair loss and an absence of the hair follicle openings.

Hair loss in LPP is permanent. The treatment is geared at stopping further hair loss. LPP responds to oral steroids and steroids injected into the lesions, especially in the early stages. Topical steroid creams may be effective in a few patients. Some studies have shown that oral vitamin A derivatives (retinoids) may be effective. Once the hair loss progresses to scarring, most treatments are ineffective.

Chieregato C et al: Lichen planopilaris: Report of 30 cases and review of the literature. Int J Dermatol 2003;42:342.
Ghislain PD, Van Eeckhout P, Ghislain E. Lassueur-Graham Little-Piccardi syndrome: a 20-year follow-up. Dermatology 2003;206:391-2.
Mehregan DA et al: Lichen planopilaris: Clinical and pathologic study of 45 patients. J Am Acad Dermatol 1992;27:935.

Mollie Jan, D.O.
Department of Dermatology
Philadelphia College of Osteopathic Medicine/Frankford Hospital
Philadelphia, Pennsylvannia.

Stephen M. Purcell, D.O., F.A.O.C.D.
Professor and Chairman of the Department of Dermatology
Philadelphia College of Osteopathic Medicine
Philadelphia, Pennsylvannia