Lichen Planopilaris: Causes, Symptoms and Treatment

Some news you might not want to hear: Lichen Planopilaris (LPP) is a skin disease that can lead to hair loss. 

It’s a type of lichen planus, which causes inflammation and affects your skin cells and mucous membranes. Some people may refer to LPP as follicular lichen planus. 

Lichen planopilaris can result in scarring hair loss, which is permanent. Here’s some good news: The condition is fairly rare, especially among men. 

Want to learn more about LPP? Keep reading to find out more about the cause, symptoms and effective treatments. 

What Exactly Is Lichen Planopilaris? 

As previously mentioned LPP is a skin disease that leads to scarring hair loss. 

There are actually three types of lichen planopilaris: 

• Classic Lichen Planopilaris: This skin disease is associated with inflammation of the hair follicles that leads to scarring and permanent hair loss.

• Frontal Fibrosing Alopecia: This form of LPP is identified by progressive hair loss that happens slowly and can cause scarring near the forehead. Occasionally, the eyebrows and eyelashes can be affected.

• Lassueur Graham-Little Piccardi Syndrome: Most commonly affecting women, this type of LPP leads to patchy scarring hair loss, thinning hair in the armpit and groin area, and rough bumps around the hair follicles. 

LPP mostly affects adult women between the ages of 40 and 60, though men can get it, too.

What Causes Lichen Planopilaris? 

The exact cause of LPP is unknown. It is thought that it could be the result of an autoimmune issue. 

The most commonly believed explanation is that white blood cells destroy skin and hair cells. 

Generally, LPP is diagnosed via a physical examination and a microscopic look at a piece of tissue from the affected area taken through a punch biopsy.

What Are the Symptoms of Lichen Planopilaris? 

As with any disorder or disease, different people may experience different symptoms of LPP. 

These are the most common symptoms:

• Patchy hair loss

• Redness on the scalp

• Scalp pain

• Itchiness of the scalp

Lichen planopilaris most commonly presents as smooth, white patches, and there’s typically no hair in the patch area when on the scalp. 

You may notice redness around the hair follicles around the edges of these bald patches. 

Usually the areas of the scalp that are affected are either the front, sides or lower back (part of the head).

What are Treatment Options for Lichen Planopilaris?

Ideally, you want to treat LPP as early as possible. Because hair loss is permanent with LPP, the earlier you begin treating it, the less potential hair loss you will face. 

The goal of treatment is to stop hair loss and manage symptoms.

Anti-inflammatory medication is often prescribed to patients with lichen planopilaris. If you are diagnosed with LPP, a healthcare professional may prescribe you one of the following:

• Topical corticosteroids

• Oral corticosteroids

• Corticosteroid injections

• Anti-malarial medication like hydroxychloroquine

• Retinoids

Minoxidil, a topical treatment, may also be prescribed by your healthcare provider to encourage hair growth in the unaffected hair follicles.

Though exactly how minoxidil works is unknown, it’s believed to work by stimulating the hair follicle to enter the anagen (growth) phase. 

Minoxidil comes in two strengths: a 2% concentration and a 5% version. Neither version of minoxidil requires a prescription. 

You can purchase a 5% minoxidil solution and a minoxidil foam version online. 

Where to Start If LPP Happens to You 

Lichen planopilaris is a scalp disease that can lead to scarring, which can cause permanent hair loss. 

Along with hair loss, people who deal with LPP may also notice redness and itching. 

For the most part, LPP is most commonly found in middle-aged women — but it is something men can get, too. 

If you suspect you may have this type of follicular lichen planus, it is crucial to speak with a healthcare professional as soon as possible so that you may review hair loss treatment options. This will help you minimize patches of hair loss as much as possible. 

Treatment of lichen planopilaris may include topical or oral corticosteroids, anti-malaria medications or retinoids.

A healthcare professional may also suggest using minoxidil to encourage hair growth in your healthy hair follicles. 

Your best first step is to contact a healthcare professional and assess what’s causing your hair loss, along with the best treatment options for you.