Lichen planopilaris

Information about lichen planopilaris

Lichen planopilaris is a primary form of scarring alopecia of unknown origin that can affect both men and women, although it is more common in women, typically between the ages of 30 and 60.

This type of alopecia mainly affects the vertex (crown) and interparietal areas of the scalp. However, it may also present in a diffuse manner, giving rise to a pattern known as fibrosing alopecia in a pattern distribution (FAPD).

It is estimated that around half of patients with this form of alopecia also develop lichen planus lesions affecting the skin, mucous membranes or nails.

Causes of lichen planopilaris in women and men

The exact cause of lichen planopilaris is not fully understood. What is known is that it is an autoimmune condition, meaning that the body’s immune system attacks the hair follicle, leading to its destruction. This process may be triggered by various endogenous and exogenous factors, such as viral infections, medications or exposure to sensitising substances. Emotional stress and psychological strain may also act as triggering factors in this autoimmune response.

In all cases, this abnormal immune response ultimately affects follicular stem cells, leading to scarring that prevents hair regeneration and, consequently, the growth of new hair.

Symptoms of lichen planopilaris

Lichen planopilaris typically presents with the progressive appearance of small patches of alopecia in the vertex and interparietal regions of the scalp. These irregularly shaped patches enlarge over the years and tend to merge, forming larger alopecic areas which, if left untreated, become irreversible and result in significant cosmetic disfigurement.

Patients frequently report associated symptoms such as itching, burning or scalp hypersensitivity in the affected areas. These symptoms may appear months before visible hair loss, as alopecic patches usually develop slowly and progressively, although more rapidly progressive cases do occur. Lichen planopilaris may also coexist with lichen planus affecting other parts of the body, such as the oral mucosa.

Diffuse forms of the disease, known as fibrosing alopecia in a pattern distribution, may present with diffuse hair loss accompanied by inflammatory signs on trichoscopy. Correct identification of this presentation is essential in order to initiate anti-inflammatory treatment and halt disease progression.

“Early diagnosis and prompt treatment are essential, as lichen planopilaris is a form of scarring alopecia”

Diagnosis of lichen planopilaris

The diagnosis of lichen planopilaris is made during consultation through a detailed clinical history and physical examination. Digital trichoscopy is also performed to assess the structure of the hair fibre and identify features not visible to the naked eye.

In some cases, histological analysis may be required, which involves performing a scalp biopsy to assess the degree of inflammation or resolve diagnostic uncertainty. This is a simple outpatient procedure that takes less than 15 minutes, is performed under local anaesthesia and requires only a single suture after sampling.

From an analytical perspective, assessment of thyroid function is recommended, as lichen planopilaris is frequently associated with autoimmune hypothyroidism.

Treatment of lichen planopilaris in women and men

At present, there is no curative treatment for lichen planopilaris. However, when appropriate therapy is initiated in the earliest stages of the disease, the development of scarring areas can be reduced and, in some cases, alopecic patches may be reversed where irreversible follicular destruction has not yet occurred.

For this reason, early diagnosis and prompt treatment are crucial, as lichen planopilaris is a scarring form of alopecia. As hair loss progresses, the affected areas develop scar tissue that permanently prevents hair regrowth.

More information

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