What Is Lichen Planopilaris Or LPP Hair Loss?

Hair loss, a condition affecting a large population, has many different types and causes. Some hair loss conditions are rare but highly disruptive and impactful. Likewise, Lichen Planopilaris, a permanent hair loss condition characterized by inflammation and scarring.

Early diagnosis of this condition is crucial for effective management. Read on to find out what is lichen planopilaris or LPP hair loss, its causes, symptoms, and treatment options.

What Is Lichen Planopilaris?

“Lichen Planopilaris or LPP is an uncommon inflammatory condition that causes permanent hair loss.”

It develops bald patches with scars causing itching, burning, or pain on the scalp and affects hair follicles. A type of Lichen planus (LLP scalp) may trigger hair loss on other body parts including eyebrows and pubic hair.

LPP hair loss mostly affects females between 40 and 60; however, adults of any age can develop it. About 1% of cicatricial (scarring) alopecia cases are caused by Lichen planopilaris.

Lichen planopilaris usually has three common types:

• Classic Lichen Planopilaris: Characterized by inflammation and scarring, leading to permanent bald patches.
• Frontal Fibrosing Alopecia: Scarring and hair loss in eyebrows and near forehead.
• Graham Little Piccardi Syndrome: Characterized by gradual hair loss in the scalp, weakened armpit hair, and uneven bumps near the hair follicles.

What Causes Lichen Planopilaris?

LPP’s actual cause is still unknown. It is not a hereditary disease but genetic factors or certain drugs may trigger it. It is an autoimmune condition in which white blood cells i.e., lymphocytes mistakenly attack skin and hair follicles.

There are two main reasons the immune system might attack hair follicles:

Genetic Immune Response

Some people have genetic variations in protein that help the immune system distinguish body’s cells from foreign cells. Due to these differences, the immune system doesn’t recognize hair follicles as part of the body and destroys them.

PPAR Gamma Deficiency

Lichen planopilaris scalp has reduced PPAR gamma protein responsible for maintaining hair follicle health and sebaceous glands. This results in growth of harmful lipids that cause the immune system to attack and destroy glands and hair cells.

Lichen Planopilaris Symptoms: How To Identify It Early?

Lichen planopilaris symptoms gradually affect the front, back, and sides of the scalp. Early signs include:

• White bald patches due to complete hair loss
• Shiny, smooth skin in patchy areas
• Itching, burning, or tenderness
• Redness and scaling on hair scalp
• Persistent scalp pain

How Is Lichen Planopilaris Diagnosed?

Early lichen planopilaris diagnosis is crucial to develop a treatment plan that controls its spread. Diagnostic tests include:

• Blood tests: A blood test to check for markers (ESR & CRP) of LPP hair loss or lichen planus.
• Biopsy: A microscopic examination of tissue taken out from the affected scalp to check if its cell pattern resembles LPP hair loss.
• Dermoscopy: A magnifying tool with a light is used to closely monitor the affected scalp without removing the tissue from the scalp.
• Trichoscopy: It reveals hair follicles that are lost and white dots.

Lichen Planopilaris Treatment: Can It Be Cured?

Lichen planopilaris (LLP) scalp causes inflammation and scarring hair loss on the scalp. Treatment goal is to stop its progression and includes topical treatments, tablets, and injections.

• Topical corticosteroids for mild inflammation
• Corticosteroid injections for severe cases
• Immunosuppressive drugs like;
  • • Azathioprine
    • Mycophenolate mofetil
    • Cyclosporine
• Medications include;
  • • Tetracyclines
    • Griseofulvin
    • Minoxidil
    • Naltrexone
• Anti-diabetic drug e.g. Pioglitazone

• Wigs, hairpieces, and hair colors to conceal hair loss
• Hair transplant
• Retinoids, available in creams or pills form, for skin cell growth.
• Omega-3 and turmeric for anti-inflammatory effects.

How To Stop Lichen Planus From Spreading?

Lichen planus scalp can be treated with medications, but it is not always possible to completely heal it. However, one should stop it from spreading to other body parts with some lifestyle changes and ointments.

• Use steroid creams and ointments to minimize inflammation.
• Use drugs that suppress immune system activity to control lymphocytes from attacking other parts of the body.
• Manage stress through breathing exercises or yoga to reduce triggers of lichen planus flare-ups.
• Avoiding itching and skin injuries as lichen planus spreads in wounded areas.
• Hydrate and moisturize the skin to reduce itching and scarring.
• Applying emollients to moisturize lichen planus scalp minimizes irritation.