Cicatricial Pattern Hair Loss Is Not a Variant of Lichen Planopilaris

The document, authored by Dr. Bevin Bhoyrul, challenges the classification of cicatricial pattern hair loss (CPHL) as a variant of lichen planopilaris (LPP). The author argues that CPHL is more likely to represent end-stage androgenetic alopecia (AGA) rather than a primary cicatricial alopecia. This conclusion is based on clinical observations that CPHL is asymptomatic like AGA and lacks the perifollicular erythema and scaling seen in LPP. Histologically, CPHL is characterized by features such as mild peri-infundibular or peri-isthmic lymphocytic infiltrate, concentric lamellar fibrosis, and loss of sebaceous glands, but without the interface changes in the follicular epithelium that are present in FAPD. The distinction between FAPD and CPHL is crucial for treatment decisions, as patients with LPP variants are not suitable for hair transplantation, while those with AGA may be. The author suggests that CPHL should not be considered a variant of LPP and that it represents end-stage AGA with follicular dropout and fibrosis.