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Lichen Planopilaris (LPP)

What is lichen planopilaris?

LPP is a scalp condition that causes hair loss and creates hairless areas on the head. It is an autoimmune disease of unknown etiology.Medications, such as hypertensive medications, are likely to cause follicular lichen to appear on the scalp. This condition affects women more often than men.

Lichen planopilaris is the cause of one third of all cases of scarring alopecia on the scalp. In scarring alopecia the loss of hair is permanent. The condition is found exclusively in the scalp, since in 50% of cases there is no evidence of the condition in the rest of the body. The condition mainly affects the top of the scalp, but does not affect the rest of the scalp.

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What are the symptoms of LPP and how is it diagnosed?

The first symptom of Lichen is local itching and hair loss, accompanied by erythema and scales around the affected hairs in the scalp area. Subsequently, empty spots appear, with a picture of scarring alopecia.

In 50 % of cases where the manifestations of the condition are limited to the scalp, i.e. there is no evidence on the genitals, nails and other parts of the body, diagnosis is difficult. This is because the appearance of LPP is similar to other skin inflammations that cause hair loss (e.g. lupus erythematosus of the skin).

The biopsy is a procedure which is performed under local anaesthesia in the doctor’s office and it is important that it is performed by a qualified dermatologist in order to have the final  diagnosis.

What are the forms of LPP?

Graham-Little-Piccardi-Lassueur syndrome

Graham-Little-Piccardi-Lassueur syndrome combines lesions of the follicular  lichen on the scalp with alopecia in the eyebrow and armpit area. Sometimes there are  characteristic papules in the region of the temples and forehead that look like acne pimples.

This syndrome is most often seen in adult women.


Scarring of the frontal area(Frontal Fibrosing Alopecia)

Frontal Fibrosing Alopecia  affects postmenopausal women and is presented  with localized hair loss in the temporal and frontal region.

The condition is progressively expanding.


How we  treat LPP?

The dermatologist will recommend the appropriate treatment depending on the specifics of the disease manifestation in each patient.

The main treatment of follicular lichen is corticosteroids, which are applied topically or taken orally.

A specific treatment is intravenous injections of slow-release and sustained-release cortisone at the site of the skin where the problem occurs. The injections are carried out at intervals of 2-3 weeks.

Other alternative treatments, such as retinoids and antimalarial hydroxychloroquine, are used in very specific cases.

In conclusion,  lichen planopilaris, must be treated appropriately by a qualified dermatologist, otherwise it leaves sections of the scalp empty of hair, as well as a gradual receding and expansion of the condition. It is important, the patient at the very first symptoms of the condition to be alarmed and contact his/her dermatologist immediately for early diagnosis and appropriate treatment.

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