Lichen Planopilaris

An Inflammatory Form of Scarring Hair Loss

Lichen planopilaris, often abbreviated to LPP, is an inflammatory condition affecting the hair follicles.

The inflammation can damage and ultimately destroy affected follicles, replacing them with scar tissue and causing permanent areas of hair loss.

Because lost follicles cannot naturally regenerate once scarring is established, the priority is to identify active disease and control progression wherever possible.

---

What Causes Lichen Planopilaris?

The precise cause of LPP remains unknown.

It is thought to involve an abnormal immune response in which inflammatory cells target structures within the hair follicle.

LPP is related to the inflammatory skin condition lichen planus, although somebody can develop scalp LPP without necessarily having obvious lichen planus elsewhere.

---

Symptoms of LPP

The appearance and symptoms can vary.

Patients may notice:

• Irregular areas of hair loss
• Increased scalp visibility
• Redness around individual follicles
• Scaling around hairs
• Itching
• Burning
• Tenderness or scalp discomfort

In affected areas where follicles have been permanently lost, the scalp can become smooth and follicular openings may no longer be visible.

Some people experience substantial symptoms, while others notice relatively little discomfort.

---

Why Diagnosis Is Important

LPP can resemble other causes of hair loss, particularly other scarring alopecias.

Assessment may therefore involve:

• Examination of the distribution of hair loss
• Identification of active inflammation
• Digital trichoscopy
• Review of symptoms and progression
• Medical history
• Examination for other scalp or skin changes

A dermatologist may recommend a scalp biopsy to confirm the diagnosis or distinguish LPP from another inflammatory scalp disorder. Histological examination can help identify the type of inflammation affecting the follicles.

---

Treatment and Management

The primary purpose of treatment is usually to reduce active inflammation and prevent further permanent follicular loss.

Several topical, injected and systemic medical treatments may be considered depending on the severity and activity of the condition, but response varies between individuals.

Where specialist prescription management is required, patients may need dermatological involvement.

Even when inflammation has been successfully controlled, hair that has already been lost through established scarring will not normally regrow naturally.

---

Can LPP Become Stable?

Lichen planopilaris may eventually become inactive, although the course differs between patients.

The fact that symptoms have settled does not always mean that the condition should immediately be assumed to be completely inactive, so ongoing assessment may sometimes be appropriate. BAD notes that LPP usually stabilises eventually, but the timing is variable.

---

Hair Replacement and Hair Transplantation

Where permanent hair loss has occurred, non-surgical hair replacement can provide an effective cosmetic option regardless of whether natural regrowth is possible.

Hair transplantation may sometimes be considered once LPP has been stable for a sustained period, although reactivation of inflammatory disease can affect transplanted follicles and results are therefore less predictable than in conventional pattern hair loss.

Any surgical plan should therefore follow careful assessment of disease stability.