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Lichen planopilaris
See also in: Hair and Scalp
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Lichen planopilaris

See also in: Hair and Scalp
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Contributors: Vivian Wong MD, PhD, Jeffrey M. Cohen MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Lichen planopilaris (LPP), also referred to as follicular lichen planus (LP), lichen follicularis, and lichen planus acuminatus, is characterized by perifollicular erythema and scale that can progress to cicatricial (scarring) alopecia over time. As in lichen planus, LPP is thought to be caused by dysfunction in cell-mediated immunity. In LPP, the immune privilege of the hair follicle bulge is felt to be lost, resulting in loss of hair stem cells after attack by activated T-lymphocytes targeting follicular antigens and an inability of hair to regrow. LPP may present in association with LP, although it is often seen alone. LPP affects women more commonly than men. Those with lighter skin phototypes are more often affected than individuals with darker skin phototypes. The onset of LPP is frequently between 40 and 60 years of age, although the condition has been described in children.

The condition may have an insidious or fulminant onset with hair loss in variable patterns. There are 3 distinct variants of LPP: classic LPP, frontal fibrosing alopecia, and Graham-Little-Piccardi-Lassueur (or 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-Piccardi-Lassueur syndrome consists of the triad of cicatricial alopecia of the scalp, a lichenoid follicular eruption, and noncicatricial pubic and axillary hair loss.

Increased hair shedding, severe itching, scaling, burning, and tenderness are common symptoms associated with LPP.

Pediatric Patient Considerations:
LPP is very uncommon in children.

Related topics: Oral lichen planus, Lichenoid drug eruption

Codes

ICD10CM:
L66.1 – Lichen planopilaris

SNOMEDCT:
64540004 – Lichen planopilaris

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Less commonly, nonscarring alopecias can be confused for LPP:
  • 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.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 02/13/2018
Last Updated: 05/03/2019
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Lichen planopilaris
See also in: Hair and Scalp
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Lichen planopilaris : Scalp
Clinical image of Lichen planopilaris
A close-up of late stage lichen planopilaris showing a wrinkled pink-white plaque of scarring alopecia on the scalp.
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