Lichen Planopilaris-Like Changes Arising Within an Epidermal Nevus: Does This Case Suggest Clues to the Etiology of Lichen Planopilaris?

    Kathleen J. Smith, J. Jay Crittenden, Henry G. Skelton
    Studysummary This case study suggests that overgrowth of microorganisms with hyperkeratosis may contribute to the induction of lichen planopilaris by disrupting the immune privilege of hair follicles. Our plain-language summary of this paper — not a Tressless recommendation.
    The study presented a case of a 14-year-old black male with a congenital raised epidermal lesion on the scalp that developed into hair loss and verrucous skin changes. Histological analysis revealed features of an epidermal nevus with central characteristics of lichen planopilaris, along with marked hyperkeratosis and increased yeast and bacteria in the follicles. The findings suggested that overgrowth of microorganisms and hyperkeratosis might disrupt the immune privilege of hair follicles, leading to an immunologic reaction confined to the follicles, potentially providing insights into the etiology of lichen planopilaris.
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