Lichen planus

What is lichen planopilaris?

Lichen planopilaris is a rare inflammatory condition resulting in patches progressive permanent hair loss mainly on the scalp. Three forms are recognized:

• Lichen planopilaris classical, also known as follicular lichen planus
• Frontal fibrosing alopecia
• Graham little syndrome

Who gets lichen planopilaris and why?

Lichen planopilaris generally affects young adult women, although the age range is wide and it also affects men. It commonly develops in association with lichen planus that affects the skin, mucous membrane and nail.

The cause of lichen planopilaris is unknown.

Although lichen planopilaris is rare, it is one of the common causes of scarring of scalp hair loss.

Clinical characteristics of lichen planopilaris

Lichen planopilaris usually presents as smooth white patches of hair loss on the scalp. Hairless follicle Openings can be seen in areas of hair loss. At the edges of these patches, there may be scale and redness around each hair follicle. The hairs can be easily pulled out. It is multifocal and small areas can merge to form larger irregular areas.

Common sites of involvement are the sides, front, and lower back of the scalp.

Symptoms are often absent, but can include:

• Chop
• Pain
• Sensitivity
• Discomfort
• Burning

Lichen planopilaris is usually slowly progressive.

Diffuse Hair loss is rare.

How is lichen planopilaris diagnosed?

Lichen planopilaris is suspected on clinical presentation and careful examination of the mouth, nails, and skin for evidence of lichen planus elsewhere.

Trichoscopy reveals absence folliclestubular, white dots peripheral scale and peripollicular erythema.

The diagnosis can be confirmed on the scalp. biopsy That includes surrounding red hair and scales on the edge of an area of hair loss. Lichen planopilaris is an example of primary lymphocytic folliculitis

However, it is not always possible to make a biopsy diagnosis. Biopsy of an already marked area of hair loss is not helpful. Where there is only hair loss with patchy scars and no evidence of inflammation The diagnosis may not be confirmed.

Lichen Planopilaris Treatment

Treatment should be sought and provided early as no treatment recovers hairs that have been lost and replaced by scars. The goal of treatment is to slow the progression of the disease and relieve symptoms. Hair loss can continue, albeit at a slower rate.

Anti-inflammatory Treatment options include:

• Corticosteroids - potent currentoral intralesional
• Topical tacrolimus
• Hydroxycoquine

• Tetracycline, for example doxycycline

• Acitretin
• Methotrexate
• Cyclosporine
• Mycophenolate mofetil
• Pioglitazone (an oral PPAR-γ agonist)

Response to treatment is variable and some published studies contradict others in terms of effectiveness. The best that patients can hope for is to halt the progression of hair loss and minimize scalp discomfort.

Mirmirani et al suggested a management protocol in 2003:

• Make a diagnosis of lichen planopilaris clinically and with a scalp biopsy.
• The severity of symptoms, the degree of hair loss, and the presence of disease activity are documented at each visit, approximately every 3 months.
• Oral hydroxychloroquine (usually 200 mg twice daily) is started after appropriate laboratory tests and eye examination if the patient has symptoms, has progressive hair loss, or signs of active disease.
• Strong topical intralesional corticosteroids can also be used.
• After 2-4 months, hydroxychloroquine is switched to cyclosporine (3-5 mg / kg / day) if symptoms continue, the degree of hair loss progresses, or there are clinical signs of disease activity. Cyclosporine is used according to the Consensus Guidelines for Cyclosporine.

Since 2009, there have been several reports on the use of the antidiabetic agent pioglitazone (off-label) for the treatment of lichen planopilaris. Its effectiveness has varied; Up to 50-70% of patients have reduced symptoms, inflammation, and disease progression. Side effects include ankle swelling and weight gain. Adalimumab, a tumor necrosis Factor alpha (TNFα) inhibitor has also been reported to be effective in some patients.

Camouflage with careful styling and hair coloring. Hairpieces may be required for areas of permanent hair loss.

Surgery such as scalp and hair reduction. transplant It has been used for end-stage disease with large areas of scarring, but it is not always successful.