Lichen Planopilaris (Scarring Alopecia) in a Child

A 12-year-old boy presented with progressive, asymptomatic patchy hair loss on the scalp, which later formed a large bald patch accompanied by dusky blue eruptions on the upper lip and eyebrows. Examination revealed plaques of alopecia with erythema, smooth, shiny, atrophic skin, and well-demarcated lesions with erythematous, scaly, follicular papules. Histopathological analysis showed hyperkeratosis, hypergranulosis, and destruction of the basal cell layer in the upper lip, and atrophy of the epidermis, fibrosis of the dermis, and dilated hair follicles with keratotic plugs in the scalp. Treatment with ultramicronized griseofulvin and prednisolone for 6 months, supplemented with topical betamethasone dipropionate, resulted in an excellent response, with a noticeable decline in the inflammatory infiltrate.