Overview of Lichen Planopilaris: Diagnosis and Treatment

July 2018 in “ Elsevier eBooks ”

Nisha S. Desai, Paradi Mirmirani

Studysummary This study highlights lichen planopilaris as a form of scarring hair loss with symptoms like shedding and itching, and notes successful treatment options such as topical and oral antiinflammatory medications to preserve hair follicles by early intervention.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The document from 2019 provides an overview of Lichen Planopilaris (LPP), a scarring alopecia with autoimmune etiology, affecting mainly Caucasian middle-aged females. It is associated with certain HLA alleles, hypothyroidism, and polycystic ovarian syndrome, with pathogenesis linked to sebaceous gland dysfunction and a defect in PPAR-y protein. Diagnosis is made through dermoscopy and histopathology, showing characteristic features like perifollicular erythema. Treatment options include topical corticosteroids, calcineurin inhibitors, and systemic therapies such as tetracycline antibiotics, with doxycycline and minocycline having a 57% response rate. Hydroxychloroquine is the gold-standard systemic treatment with a 53-83% response rate. Other treatments like thiazolidinediones, oral retinoids, and mycophenolate mofetil (with an 83% effectiveness in a 16-patient series) are considered, while cyclosporine A and oral prednisone are reserved for short-term use. Early diagnosis and potentially combined treatments are crucial for preventing permanent hair loss.

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Research cited in this study

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research Prevalence of Hormonal and Endocrine Dysfunction in Patients with Lichen Planopilaris: A Retrospective Data Analysis of 168 Patients

44 citations , February 2017 in “Journal of the American Academy of Dermatology”

This study found that postmenopausal women with lichen planopilaris showed a high prevalence of androgen excess, while women with frontal fibrosing alopecia were often associated with androgen deficiency.

research Primary Cicatricial Alopecia: Treatment Approaches and Classification

95 citations , November 2016 in “Journal of The American Academy of Dermatology”

This article reviews primary cicatricial alopecias, focusing on lymphocytic forms such as chronic cutaneous lupus erythematosus, according to a classification by the North American Hair Research Society, and reports no new clinical results.

research A New Subtype of Lichen Planopilaris Affecting Vellus Hairs and Clinically Mimicking Androgenetic Alopecia

9 citations , September 2016 in “Dermatologic Surgery”

This study identified a new subtype of lichen planopilaris that mimics androgenetic alopecia, selectively affecting vellus hair follicles and presenting unique histopathological features.

research Linear Lichen Planopilaris of the Face: Case Report and Review

5 citations , January 2016 in “Skin appendage disorders”

This case report describes a rare occurrence of lichen planopilaris on the face in a 45-year-old man, contributing to the limited existing cases in the literature.

research Lichen Planopilaris Epidemiology: A Retrospective Study of 80 Cases

37 citations , October 2015 in “Anais Brasileiros de Dermatologia”

This study found diverse clinical presentations of lichen planopilaris, with classic lichen planopilaris being the most common, highlighting the importance of recognizing this variability for accurate diagnosis.

research The Use of Oral Pioglitazone in the Treatment of Lichen Planopilaris

58 citations , January 2015 in “Journal of the American Academy of Dermatology”

Pioglitazone may help treat lichen planopilaris, but more research is needed.

research Efficacy of Oral Retinoids in Treatment-Resistant Lichen Planopilaris

16 citations , October 2014 in “Journal of the American Academy of Dermatology”

This study found that oral retinoid therapy may provide clinical improvement in a small percentage of patients with treatment-resistant lichen planopilaris, although it is not commonly used as a first-line treatment.

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”

This retrospective review found that while intralesional corticosteroids provided symptomatic improvement for lichen planopilaris, hydroxychloroquine with topical corticosteroids led to higher remission rates but did not result in visible hair regrowth.

Lichen Planopilaris Treated by the Peroxisome Proliferator-Activated Receptor-γ Agonist Pioglitazone: Lack of Lasting Improvement or Cure in the Majority of Patients

research Lichen Planopilaris Treated by the Peroxisome Proliferator-Activated Receptor-γ Agonist Pioglitazone: Lack of Lasting Improvement or Cure in the Majority of Patients

33 citations , October 2013 in “Journal of The American Academy of Dermatology”

In this study, pioglitazone treatment in patients with lichen planopilaris showed limited success, with significant improvement seen in only a minority of cases.

research Treatment of Frontal Fibrosing Alopecia and Lichen Planopilaris: A Systematic Review

117 citations , March 2013 in “Journal of the European Academy of Dermatology and Venereology”

This study reported that while no effective treatment exists for frontal fibrosing alopecia, oral 5-alpha-reductase inhibitors showed the most promise, inducing a good clinical response in 45% of patients.

research Cicatricial Alopecia Symposium 2011: Lipids, Inflammation, and Stem Cells

4 citations , May 2012 in “Journal of Investigative Dermatology”

This symposium discussed the role of lipids, inflammation, and stem cells in cicatricial alopecia but reports no new research findings; it highlights lipid pathways as significant in these hair disorders.

research Sebaceous Gland Loss and Inflammation in Scarring Alopecia: A Potential Role in Pathogenesis

37 citations , June 2011 in “Journal of The American Academy of Dermatology”

This study demonstrates that sebaceous gland loss is a common early feature in primary scarring alopecia and suggests that inflammation of sebaceous glands or ducts may contribute to follicular damage.

research The HoVert Technique: A Novel Method for the Sectioning of Alopecia Biopsies

44 citations , January 2011 in “Journal of Cutaneous Pathology”

This study introduces the "HoVert" technique, which generates both vertical and horizontal sections from a single biopsy to effectively differentiate lichen planopilaris from discoid lupus erythematosus in alopecia cases.

research Efficacy and Safety of Mycophenolate Mofetil for Lichen Planopilaris

66 citations , January 2010 in “Journal of The American Academy of Dermatology”

This study reported that mycophenolate mofetil was effective in reducing signs and symptoms of active lichen planopilaris in 83% of patients who had failed multiple prior treatments.

research Lichen Planopilaris: Chronic Scarring Alopecia with Autoimmune Component

90 citations , July 2008 in “Dermatologic therapy”

This article reviews lichen planopilaris, a chronic scarring alopecia, and explores recent treatment developments, but it reports no new clinical results.

research Onset of Lichen Planopilaris During Treatment with Etanercept

39 citations , March 2008 in “British Journal of Dermatology”

This study documented the onset of lichen planopilaris during treatment with etanercept.

research Linear Lichen Planopilaris of the Trunk: First Report of a Case

18 citations , May 2006 in “Journal of Cutaneous Medicine and Surgery”

This study reports the first known case of linear lichen planopilaris following Blaschko's lines in a nonfacial region.

research The Medical Treatment of Cicatricial Alopecia

46 citations , March 2006 in “Seminars in Cutaneous Medicine and Surgery”

This review discusses treatment strategies for cicatricial alopecia based on histopathologic findings, emphasizing the challenges due to overlapping and evolving histopathologic features, but reports no new clinical results.

research Report From The Cicatricial Alopecia Colloquium

15 citations , February 2006 in “Journal of Investigative Dermatology”

More research is needed to understand and treat cicatricial alopecias.

research Scd1 ab-Xyk: A New Asebic Allele Characterized by a CCC Trinucleotide Insertion in Exon 5 of the Stearoyl-CoA Desaturase 1 Gene in Mouse

12 citations , July 2004 in “Molecular genetics and genomics”

This study identifies a new mutation in the Scd1 gene in a strain of Kunming mice, causing skin and hair defects with the mildest impact among similar mutations.

research Primary Cicatricial Alopecias: Clinicopathology of 112 Cases

254 citations , December 2003 in “Journal of the American Academy of Dermatology”

This study reviewed the epidemiology and treatment of inflammatory cicatricial alopecias and highlighted the importance of scalp biopsies for accurate diagnosis in a mixed ethnic population at a university hair clinic.

Cyclosporin A-Induced Hair Growth in Mice Is Associated with Inhibition of Calcineurin-Dependent Activation of NFAT in Follicular Keratinocytes

research Cyclosporin A-Induced Hair Growth in Mice Is Associated with Inhibition of Calcineurin-Dependent Activation of NFAT in Follicular Keratinocytes

57 citations , June 2003 in “American Journal of Physiology-cell Physiology”

This study found that cyclosporin A treatment enhances hair growth in mice by inhibiting calcineurin-NFAT1 activity, which alters keratinocyte differentiation and apoptosis-related gene expression in hair follicles.

research Asebia-2J (Scd1ab2J): A New Allele and a Model for Scarring Alopecia

179 citations , June 2000 in “The American journal of pathology”

This study reports that the asebia-2J mutation in mice affects sebaceous gland function and leads to hair follicle destruction, offering a model for human scarring alopecias.

research Fibrosing Alopecia in a Pattern Distribution

158 citations , February 2000 in “Archives of dermatology”

This study reports that some patients with androgenetic alopecia may also exhibit clinical and histological features of inflammation and fibrosis, similar to those found in lichen planopilaris.

research Hair Follicle Biology, the Sebaceous Gland, and Scarring Alopecias

57 citations , August 1999 in “Archives of dermatology”

Hair follicles grow hair and release it through the skin.