Lichen Planopilaris: Unveiling Causes, Symptoms, and NIS Treatment Strategies

Explore the world of Lichen Planopilaris, a chronic scalp inflammation leading to patchy hair loss, predominantly affecting young adult women. NIS delves into this variant of lichen planus, characterized by distinct patterns of hair loss that can culminate in permanent damage due to Cicatricial Alopecia. In this article, NIS offers an in-depth understanding of the causes, symptoms, and various treatment options available for Lichen Planopilaris, aiming for effective management and patient care.

What is Lichen Planopilaris?

Lichen Planopilaris, identified as a scalp-specific variant of the more widespread Lichen Planus, is a chronic inflammatory condition that leads to irreversible hair loss. NIS brings to light how this disorder targets hair follicles, causing them to become inflamed, reddened, and scaly, eventually leading to hair loss and scarring. The symptoms can vary from noticeable discomfort, such as itching and pain, to no symptoms at all. This condition is categorized into three distinct subtypes, each with its unique manifestation: Classic Lichen Planopilaris, Frontal Fibrosing Alopecia, and Graham Little Syndrome. Classic Lichen Planopilaris typically shows patches of hair loss on the scalp, while Frontal Fibrosing Alopecia is recognized by a receding hairline and scarring on the front scalp, often affecting eyebrows. Graham Little Syndrome is characterized by Cicatricial Alopecia, leading to permanent hair loss on the scalp, coupled with non-scarring hair loss in other body regions. The exact cause of Lichen Planopilaris remains unclear, but the underlying process of follicular inflammation leading to scarring is a consistent finding.

 

Clinical features of Lichen Planopilaris

NIS sheds light on the distinctive clinical characteristics of Lichen Planopilaris, highlighting its impact on the scalp. This condition is marked by the emergence of specific lesions characterized by perifollicular erythema (redness around hair follicles) and scaling. These lesions typically display a reddish hue with a tendency towards scaling or crustiness, especially around their edges. The hair follicles show clear signs of inflammation, leading to the formation of bald patches. These patches, varying in size and number, usually present a smooth, whitish appearance and can merge to create larger areas of hair loss. Although primarily affecting the scalp, other hair-bearing regions are rarely involved. In Frontal Fibrosing Alopecia, a subtype, postmenopausal women experience hairline recession and scarring. Another subtype, Graham Little Syndrome, is characterized by patchy hair loss with scarring on the scalp and hair loss on other body parts. These features provide vital clues for diagnosis and understanding the disease’s progression.

What are the symptoms of Lichen Planopilaris?

Lichen Planopilaris symptoms vary widely among individuals. Typically, the disease affects the scalp’s vertex and crown areas. Most noticeable is the formation of bald patches accompanied by hair loss. These affected areas often exhibit scaling, particularly towards their edges. Common symptoms experienced by patients include pain, itching, redness, and general discomfort in the affected regions. Additionally, many suffering from Lichen Planopilaris also show symptoms of Lichen Planus, which impacts the skin and mucous membranes. This variety in symptoms plays a crucial role in the diagnosis and management of the condition.

Causes of Lichen Planopilaris

The exact cause of Lichen Planopilaris remains a mystery, making treatment challenging. Experts suspect autoimmunity plays a key role, where the body’s immune system, particularly lymphocytes, erroneously targets and damages its own tissues, specifically hair follicles. This immune misfire results in hair loss and scarring, often permanent due to stem cell destruction. Environmental factors might also trigger this abnormal immune response. Furthermore, genetic predispositions have been identified, increasing the likelihood of developing this condition. Despite these insights, the unpredictability of the disease continues to complicate its management.

Diagnosing Lichen Planopilaris

Diagnosing Lichen Planopilaris necessitates a thorough examination of the scalp by a Trichologist . A comprehensive diagnosis relies on clinical, histological, and pathological assessments. Biopsy, particularly from an active lesion displaying perifollicular erythema and scaling, is pivotal for confirmation. Additionally, the Anagen Pull test aids in confirming the diagnosis. Examination of nails, skin, and mucous membranes is conducted to detect underlying Lichen Planus. Trichoscopy, a modern non-invasive diagnostic technique, is also utilized to explore various clinical presentations on the scalp.

Treating Lichen Planopilaris

While there’s no specific cure for Lichen Planopilaris, treatments aim to alleviate symptoms and slow down disease progression. Early diagnosis offers better treatment prospects, as scarring alopecia-induced hair loss is irreversible. Treatment typically involves oral, topical, and intralesional medications, including corticosteroids administered orally, topically, or via injection. Antimalarial medications like Hydrochloroquine reduce inflammation, while immunosuppressants such as Methotrexate are prescribed. Pioglitazone, an antidiabetic drug, is also used. Treatment effectiveness varies among individuals. In advanced stages, cosmetic surgery and hair transplantation may be considered, though recovery prospects are limited, and relapse is common.

Complications of Lichen Planopilaris

Complications include Cicatricial alopecia, resulting in scarring and irreversible hair loss, often accompanied by Lichen Planus affecting skin, nails, and mucous membranes, leading to characteristic reddish-purple flat rashes and pigmentation issues.

Appearance of Lichen Planopilaris

Lichen Planopilaris presents as smooth, shiny bald patches that may fuse to form larger areas of baldness, with inflamed hair follicles appearing red and scaly. These patches can occur anywhere on the scalp, often accompanied by perifollicular erythema and scales. Other variants like Follicular Lichen Planus, Frontal Fibrosing Alopecia, and Graham Little syndrome have distinct patterns and symptoms aiding in diagnosis.

Risk Factors of Lichen Planopilaris

Risk factors include age, with middle-aged women being more susceptible, certain genetic predispositions, higher incidence among Caucasian adults, association with Hepatitis C infection, exposure to certain medications, toxins, and scalp trauma.

Outcomes of Lichen Planopilaris

Although Lichen Planopilaris may resolve spontaneously, hair loss is permanent, with frequent relapses even after years of remission. Its slow and unpredictable progression makes outcomes highly variable.