Diffuse Lichen Planopilaris Masquerading as Diffuse Alopecia Areata

March 2024 in “ Case Reports in Dermatology ”

Li Jie Helena Yoo, Nekma Meah, Dmitri Wall, Ian McDonald

diffuse lichen planopilaris diffuse alopecia areata female pattern hair loss follicular lichen planus dermoscopy biopsies oral corticosteroids minoxidil spironolactone Rogaine

TLDR A woman's hair loss was misdiagnosed as alopecia areata but was actually lichen planopilaris, needing immediate and ongoing treatment.

The document discusses a case of a 32-year-old woman who was initially diagnosed with diffuse alopecia areata, but was later found to have diffuse lichen planopilaris (LPP) and female pattern hair loss. LPP, a form of follicular lichen planus, primarily affects women aged 30 to 60. Due to the complexity and atypical nature of the patient's condition, dermoscopy-guided vertical and horizontal biopsies were used to improve diagnostic accuracy. The patient was treated with oral corticosteroids, minoxidil, and spironolactone. The study highlights the need for immediate treatment to stop disease progression and long-term follow-up, as the disappearance of clinical signs does not necessarily mean the disease has stopped progressing.

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Research cited in this study

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research Fibrosing Alopecia in a Pattern Distribution

30 citations, January 2020 in “Journal of The American Academy of Dermatology”

Fibrosing alopecia in a pattern distribution is a hair loss condition often confused with other types, requiring early treatment but usually not resulting in significant hair regrowth.

research Lichen Planopilaris: Retrospective Study on the Characteristics and Treatment of 291 Patients

48 citations, November 2018 in “Journal of dermatological treatment”

Women are more likely to have Lichen planopilaris, and treatments with cyclosporine and methotrexate are most effective but less safe than mycophenolate mofetil.

research A Case Series of 46 Patients With Lichen Planopilaris: Demographics, Clinical Evaluation, and Treatment Experience

47 citations, June 2014 in “Journal of Dermatological Treatment”

Most treatments for lichen planopilaris were found to be generally unsatisfactory.

research Frontal Fibrosing Alopecia: A Multicenter Review of 355 Patients

339 citations, February 2014 in “Journal of The American Academy of Dermatology”

Most patients with frontal fibrosing alopecia are postmenopausal women, and treatments like finasteride and dutasteride can improve or stabilize the condition.

research Dermoscopy-Guided Scalp Biopsy in Cicatricial Alopecia

62 citations, March 2012 in “Journal of the European Academy of Dermatology and Venereology”

Using dermoscopy to guide scalp biopsies is an effective way to diagnose cicatricial alopecia.

research A Histologic Review of 27 Patients with Lichen Planopilaris

76 citations, June 2008 in “Journal of the American Academy of Dermatology”

The conclusion is that certain scalp tissue changes are characteristic of lichen planopilaris, with mucinous perifollicular fibroplasia being a new feature for diagnosis.

research The Histopathology of Alopecia Areata in Vertical and Horizontal Sections

19 citations, December 2001 in “Dermatologic Therapy”

Horizontal scalp biopsy sections are better for diagnosing alopecia areata, showing fewer hair follicles and more miniaturized hairs.

research Fibrosing Alopecia in a Pattern Distribution

158 citations, February 2000 in “Archives of dermatology”

Some people with pattern hair loss may also have scalp inflammation and scarring similar to lichen planopilaris.

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community Diffuse hair loss and scalp biopsies

in Research 692 upvotes 3 months ago

Scalp biopsies are crucial for diagnosing hair loss conditions like Diffuse Unpatterned Alopecia (DUPA) and retrograde hair loss, as treatments like finasteride and dutasteride may not be effective if other conditions are present. Combining PPAR-GAMMA agonists with retinoids could improve treatments for conditions like Lichen Planopilaris.

community I’m 14 years old and I’m losing more hair than my dad. I’ve gone to the doctor 2 times because of this and I’ve received no help. I’m starting to feel like It’s worthless and my hairs gonna look like this forever. I don’t know how anyone could help me but it’s always worth a shot.

in Treatment 4 years ago

A 14 year old who is experiencing hair loss and has not received any help from the doctor, with advice being given to try different doctors, get tested for underlying conditions and intolerances, buzz it short as an option and treatments that could slow down or reverse the hair loss such as minoxidil, finasteride, RU58841 and addressing the cause of the hair loss.

community Have been on treatment for close to two years, need to know if I should continue or take dut

in Progress Pictures 52 upvotes 2 months ago

A 22-year-old male has been using finasteride, topical minoxidil, and oral minoxidil for hair loss but sees minimal improvement and is considering adding dutasteride. Users suggest additional treatments like dermarolling, PRP, and consulting a dermatologist, or considering a hair transplant.

community scarring alopecia awareness in this community

in Chat 33 upvotes 2 years ago

Lichen Planopilaris (LPP), a form of permanent hair loss, which can be mistaken for seborrheic dermatitis and is characterized by scalp itching, burning, redness, and dandruff. Treatment options discussed include steroidal creams, finasteride, minoxidil, and RU58841.

community After Years of Treatment, I'm Shaving my Head and Giving Up

in Shaved/buzzed 119 upvotes 1 week ago

After years of using dutasteride and oral minoxidil without success, the individual decided to shave their head and stop treatment. They considered scalp micropigmentation and hair systems but ultimately accepted their hair loss.

community The Worst Hair Loss Condition You (MAY) have: LPP

in Research/Science 43 upvotes 2 months ago

Lichen Planopilaris (LPP) is an autoimmune condition causing permanent hair loss and fibrosis, often misdiagnosed. Treatments include pioglitazone, topical corticosteroids, anti-inflammatory medication, and Jak inhibitors.

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research Twenty Nail Dystrophy with Alopecia Areata in an Atopic Child

April 2019 in “International journal of research in dermatology”

A child with rough nails also had hair loss and allergies.