Notes From The Editor Emeritus: What If 10% Of Your Cases Were Lichen Planopilaris Incognito?

    Dow B. Stough
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    TLDR Up to 10% of hair loss patients might have early signs of a condition called Lichen Planopilaris.
    In 2015, Dr. Dow B. Stough discussed the prevalence of lichen planopilaris (LPP) in hair transplantation patients, typically diagnosed with common pattern alopecia. He noted an increase in reports of LPP, folliculitis, and cicatricial changes after transplantation, attributing this to increased awareness and better disease definitions rather than an actual rise in occurrence. He observed that up to 10% of all cases might have early signs of LPP, such as perifollicular erythema and subtle follicular hyperkeratosis. Reports suggested that up to 8% of all patients initially diagnosed with androgenetic alopecia could later show clinical findings of LPP. Stough raised questions about whether these were early LPP cases or if a percentage of all androgenetic alopecia cases naturally showed subtle changes consistent with LPP. He recommended vigilance in identifying early signs of LPP and questioned the effectiveness of biopsy in such cases due to its cost and delays.
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