Lichen Planopilaris: Update on Diagnosis and Treatment

Abstract

Lichen planopilaris (LPP), a follicular form of lichen planus, is a rare inflammatory lymphocyte mediated disorder. Although the physiopathology is unclear, an autoimmune etiology is generally accepted. Women are affected more than men, and the typical age of onset is between 40 and 60 years. LLP is a primary cicatricial alopecia whose diagnosis is supported in the early stage by both clinical and histopathological findings. Within the margins of the expanding areas of perifollicular violaceous erythema and acuminate keratotic plugs, the histology can show the lichenoid perifollicular inflammation. LPP can be subdivided into 3 variants: classic LPP, frontal fibrosing alopecia (FFA), and Lassueur Graham-Little Piccardi syndrome. With the exception of FFA, the hairless patches of the scalp can be unique or can occur in multiples and can present with a reticular pattern or as large areas of scarring. This condition can have major psychological consequences for the affected patients. The therapeutic management often is quite challenging, as relapses are common after local or systemic treatments. Further research is needed on the pathogenesis, and randomized controlled trials of treatment with scientific evaluation of the results are necessary to appreciate the proposed treatment.

Perda pilosa por líquen plano pilar após transplante capilar: relato de dois casos e revisão da literatura

“…10 LPP is more common in women, who account for 60% to 90% of cases, and onset is usually in the fifth to seventh decade of life. 9 As in the cases described above, lesions frequently involve the vertex, although any part of the scalp can be affected. 9 Classical early-onset lesions are characterized by violet-colored follicular erythema and acuminate keratotic plugs, preferentially located on the edge of the area affected by alopecia 6,9,10 , where the condition is expanding.…”

“…It involves a lymphocytic inflammatory process that can destroy hair follicles by replacing them with a fibrous tissue. 9,10 The condition is often chronic and recurring; while it is still of uncertain etiology, autoimmune processes are probably involved in its pathogenesis. 10 It can be divided into three variants: the classic form of LPP, frontal fibrosing alopecia and Graham-Little syndrome.…”

“…After the hair has fallen out and the inflammation has been resolved, the lesions are replaced by atrophic scars, with permanent loss of follicles. This corresponds to the final stage of any cicatricial alopecia 9 . The course of the disease is unpredictable and has no apparent resolution.…”

“…9,11 Treatment of LPP is essentially clinical and is intended to reduce the severity of the symptoms, such as discomfort, itching and hair loss, and to prevent the inflammation spreading. 9 First-line therapy continues to be intralesional injection of corticosteroids such as triamcinolone, which aims to reduce the inflammatory process and allows the progress of the alopecia to be halted, as in patient 2, whose lesions stabilized. 6,9,12 Systemic treatments have been used in cases that do not respond to this initial treatment.…”

“…8 Cicatricial alopecia can affect the whole scalp, including the donor area from where hairs are removed for transplantation. 9 The aim of this study is to describe two cases of loss of transplanted hair, probably as a result of LPP.…”