Lichen Planopilaris

What is lichen planopilaris?

Lichen planopilaris (LPP) is a condition that causes inflammation in your scalp and hair follicles. It often causes scarring and patches of permanent hair loss, usually on your head.

Who does lichen planopilaris affect?

LPP happens most often in women and people assigned female at birth who are 40 to 60 years of age. But it can also affect adults of any sex or age.

How common is lichen planopilaris?

LPP is the leading cause of scarring alopecia (hair loss due to scarring). But when compared to all types of hair loss, LPP is the cause in about 1% of cases.

What are the types of lichen planopilaris?

There are three types of lichen planopilaris:

• Classic lichen planopilaris: Scarring causes bald patches on your scalp.
• Frontal fibrosing alopecia: Bald patches and scarring appear at your hairline near your forehead. You may also lose hair in your eyelashes or eyebrows.
• Lassueur-Graham-Little-Piccardi syndrome: You may have scarring and bald patches on your scalp, as well as thinning hair in your armpits and groin. You may also notice rough bumps around your hair follicles.

What are the symptoms of lichen planopilaris (LPP)?

Lichen planopilaris symptoms may come on quickly or gradually. If you have LPP, you might notice:

• Bald patches on your scalp.
• Red, thick or scaly patches of skin on your scalp.
• Scalp pain, itching or burning.

LPP is a form of lichen planus, a condition that causes an itchy rash on your arms and legs and in your mouth. Lichen planus can also cause ridges or splitting of your nails. Nearly half of people with LPP also develop symptoms of lichen planus.

What causes lichen planopilaris?

Experts don’t fully understand what causes lichen planopilaris. However, it appears that T-cells, which are part of your immune system, attack your hair follicles.

Because T-cells are involved, many experts believe LPP is an autoimmune disease. Autoimmune means your immune system mistakenly attacks healthy tissues or organs.

Is lichen planopilaris contagious?

LPP isn’t contagious and you can’t spread it to others.

How do providers diagnose lichen planopilaris?

First, your provider may look at your scalp and skin and perform a physical examination. They may also ask you about your health history and medications you take.

Lichen planopilaris can look like other skin conditions, so you may need additional tests for a diagnosis, such as:

• Dermoscopy: Your provider uses a magnifying device with a light to take a close look at any patches of hair loss or scarring.
• Skin biopsy: During a skin biopsy, your provider takes a small sample of your skin and sends it to a lab for analysis.

How is lichen planopilaris treated?

Several different medications and therapies can help you manage the symptoms of lichen planopilaris (LPP). Most therapies for lichen planopilaris include a medication that reduces inflammation, as this is an inflammatory disorder. Your treatment plan may include:

• Antibiotics, fight bacterial infections and reduce inflammation.
• Anti-malarial drugs, treat malaria and may also help treat certain inflammatory skin conditions.
• Corticosteroids, help control inflammation.
• Low-level laser therapy, uses special light waves to treat skin inflammation.
• Retinoids, help regulate skin cell growth and treat certain skin conditions, using creams or pills.

How should I manage symptoms of lichen planopilaris?

If your treatment plan includes medications, take your medications as prescribed. See your dermatologist regularly to discuss how your treatment is working. Don’t stop taking your medications unless your dermatologist tells you to do so.

Be aware of possible mental health effects from LPP. Hair loss can sometimes lead to loss of confidence, depression or anxiety. Treatment is available for these concerns and can help you feel your best.

How can I prevent lichen planopilaris?

There’s no known way to prevent lichen planopilaris (LPP). But if you notice skin changes or hair loss, don’t ignore it. Early treatment for LPP may help prevent future scarring and hair loss.

Is there a cure for lichen planopilaris?

There isn’t a known cure for lichen planopilaris, but treatment can stop it from getting worse. You may need to try a few different treatments to find the one that works best for you. Your dermatologist can guide you through treatment that addresses your physical and mental health concerns.

How do I take care of myself if I have lichen planopilaris (LPP)?

With LPP, your scalp may be sensitive. To prevent irritation, itching or reactions on your scalp, your dermatologist may recommend or prescribe certain shampoos or hair products. In general, use hypoallergenic and gentle hair products. Avoid these ingredients in shampoos and hair products that may cause irritation:

• Alcohol (may be listed as “alcohol denatured” or “isopropyl alcohol” on the label).
• Essential oils.
• Fragrance or perfumes.
• Preservatives like parabens and methylisothiazolinone.

Some people decide to cover their scalp to conceal hair loss. Covering your head can also help protect your skin from cold air and sunlight. Options include scarves, hats or wigs, depending on your preference.

If you’re interested in a wig, ask your provider about local organizations that create wigs for people with medical conditions. You should also learn about wig care so you can keep it looking its best. Don’t overtighten your wig, and consider using a wig cap to protect your scalp and make your wig more comfortable.

When should I see my healthcare dermatologist?

See your dermatologist if your medication or treatment isn’t working for you or if you have unwanted side effects. Also, tell your dermatologist if any symptoms get worse or if you notice new symptoms.

A note from Cleveland Clinic

Lichen planopilaris (LPP) doesn’t cause serious health complications, and many people with this condition lead full, active lives. Still, symptoms like hair loss, pain and itching can be difficult to deal with. Treatment can help. Work with your provider to find a treatment that works for you and address any physical and mental concerns you’re experiencing.

A scarf, wig or hat may help your confidence, but this is a personal choice. When it comes to covering your head, do what helps you feel your best.