Follicular Lichen Planus Caused by Wig Use: An Unusual Case of Koebner Phenomenon

In the discussed case, a 58-year-old woman with a history of lichen planopilaris (LPP) developed plaques of scarring alopecia (SA) in areas where the fasteners of her wig applied pressure. The woman, who had previously been treated for telogen effluvium, female-pattern androgenetic alopecia, and LPP, wore the wig for at least 7 hours daily. After chemotherapy and radiotherapy for breast cancer, which caused anagen effluvium, she used double-sided adhesive tape over the fasteners due to insufficient hair for proper fastening. Dermoscopic examination and biopsy confirmed the presence of cicatricial fibrosis and a dense perifollicular lichenoid infiltrate in the affected areas. The authors concluded that the alopecia was a result of the Koebner phenomenon, where skin trauma (in this case, pressure and traction from the wig fasteners) leads to the development of disease-specific lesions, and highlighted that this is a rare association not previously reported in the literature.