Summary about Disease
Lichen planopilaris (LPP) is a rare inflammatory condition that affects the hair follicles of the scalp, leading to scarring alopecia (permanent hair loss). It's a variant of lichen planus, a skin disease that can affect various parts of the body. LPP specifically targets the hair follicles, causing inflammation and eventually destroying them. This results in patchy hair loss that can be progressive. There is no cure for LPP, and treatment focuses on managing the inflammation to slow down hair loss and relieve symptoms.
Symptoms
Common symptoms of lichen planopilaris include:
Itching and burning sensations on the scalp
Redness and inflammation around hair follicles
Scaling or crusting around hair follicles
Gradual, patchy hair loss, often starting at the crown of the head
Follicular papules (small, raised bumps around hair follicles)
Pain or tenderness of the scalp
In some cases, the formation of small, smooth, white or slightly red areas without hair follicles (called perifollicular scaling or pseudopelade)
Causes
The exact cause of lichen planopilaris is unknown. However, it is considered an autoimmune condition, where the body's immune system mistakenly attacks healthy tissues – in this case, the hair follicles. Genetic predisposition, environmental factors, and possibly certain triggers might play a role in the development of the disease. Research is ongoing to further understand the underlying mechanisms.
Medicine Used
Treatment for lichen planopilaris aims to reduce inflammation and slow down the progression of hair loss. Common medications include:
Topical corticosteroids: Applied directly to the scalp to reduce inflammation.
Topical calcineurin inhibitors: Like tacrolimus or pimecrolimus, may be used to suppress the immune response.
Intralesional corticosteroids: Injections of corticosteroids directly into the affected areas of the scalp.
Oral medications:
Oral corticosteroids: Like prednisone, used for more severe cases to control inflammation.
Hydroxychloroquine: An antimalarial drug with anti-inflammatory properties.
Doxycycline or tetracycline: Antibiotics with anti-inflammatory effects.
Mycophenolate mofetil or cyclosporine: Immunosuppressants used in severe cases to suppress the immune system.
Janus kinase (JAK) inhibitors: Oral medications like Tofacitinib and Baricitinib are newer medications which target inflammatory pathways and have demonstrated promising results.
Is Communicable
Lichen planopilaris is not communicable. It is not contagious and cannot be spread from person to person through any form of contact.
Precautions
While there is no way to completely prevent lichen planopilaris, certain precautions can help manage symptoms and potentially slow down the progression:
Gentle hair care: Avoid harsh shampoos, perms, dyes, and excessive heat styling.
Sun protection: Protect the scalp from sun exposure with hats or sunscreen.
Stress management: Stress may exacerbate symptoms, so practice stress-reducing techniques.
Early treatment: Seek prompt medical attention at the first signs of hair loss or scalp inflammation.
Avoid tight hairstyles: As these can put added pressure to hair follicles.
How long does an outbreak last?
The duration of a lichen planopilaris outbreak can vary significantly from person to person. It can be chronic, with periods of active inflammation (outbreaks) followed by periods of remission. Some individuals may experience ongoing, persistent inflammation, while others may have intermittent flare-ups. Without treatment, the inflammation will persist, leading to continued hair loss. Treatment aims to control the inflammation and minimize the duration and severity of outbreaks.
How is it diagnosed?
Lichen planopilaris is typically diagnosed through a combination of:
Clinical examination: A doctor will examine the scalp and assess the pattern of hair loss and any associated symptoms.
Medical history: The doctor will inquire about your medical history, including any other skin conditions or autoimmune diseases.
Scalp biopsy: A small sample of scalp tissue is taken and examined under a microscope to confirm the diagnosis and rule out other conditions. The biopsy helps to identify the characteristic inflammatory changes around the hair follicles.
Trichoscopy: A magnified view of the scalp used to examine the hair follicles and surrounding skin.
Timeline of Symptoms
The progression of lichen planopilaris symptoms can vary, but generally follows this timeline:
Early stages: Itching, burning, redness, and scaling around hair follicles. Small, raised bumps (follicular papules) may appear.
Progression: Gradual, patchy hair loss begins, often starting at the crown of the head. Inflammation persists around the affected follicles.
Advanced stages: Hair loss becomes more extensive, leading to larger bald patches. Scarring occurs, resulting in permanent hair loss in the affected areas. The scalp may become smooth and shiny in areas of scarring. The rate of progression varies from person to person. Early diagnosis and treatment are crucial to slowing down the progression and minimize permanent hair loss.
Important Considerations
Early diagnosis is critical: The earlier LPP is diagnosed and treated, the better the chances of slowing down the progression of hair loss.
Treatment is focused on management: There is currently no cure for LPP, so treatment aims to manage inflammation and prevent further hair loss.
Long-term follow-up is necessary: Individuals with LPP require ongoing monitoring and treatment to manage the condition effectively.
Emotional impact: LPP can have a significant emotional impact due to hair loss and changes in appearance. Support groups or counseling may be helpful.
Other Conditions: LPP may be associated with other autoimmune conditions.
Response to treatment varies: Not everyone responds to treatment in the same way. It may take time to find the most effective treatment regimen.