Lichen planopilaris (LPP) is a skin disease that can lead to hair loss.
Lichen planopilaris (LPP) is a skin disease that can lead to hair loss. It’s the most common type of scarring alopecia (also known as cicatricial alopecia), which is hair loss caused by scarring or permanent damage to the scalp.
LPP, specifically, is a form of lichen planus (a chronic, inflammatory type of dermatitis) that affects skin cells and mucous membranes. Some people may refer to LPP as follicular lichen planus or lichen planus of the scalp.
There are three forms of LPP that differ depending on the pattern and location of symptoms:
Classic LPP. This form of lichen planopilaris affects the scalp and hair follicles.
Frontal fibrosing alopecia (FFA). FFA affects the front and sides of the scalp.
Graham-Little-Piccardi-Lasseur syndrome (GLPLS). Sometimes called Graham-Little syndrome, this form of LPP affects the scalp, armpits, genitals, and extremities.
The condition is fairly rare, though, especially among men. Lichen planopilaris most commonly affects women ages 40 to 60, but it can happen to anyone at any time, regardless of age or sex.
As with any medical disorder or disease, different people may experience different lichen planopilaris symptoms.
These are the most common symptoms of lichen planopilaris:
Patchy hair loss
Redness on the scalp
Redness at the hair follicle
Scalp pain
Itchiness of the scalp (pruritus)
Lichen planopilaris usually shows up as smooth, white patches, and there’s typically no hair in the patchy area when it’s present on the scalp. So if you Google “lichen planopilaris scalp pictures,” that’s probably what you’ll see.
You might notice redness in the hair follicles around the edges of these bald patches. Typically, the affected areas of the scalp are the front, sides, or lower back of the head.
One study looked at 19 male patients with LPP seen at the Mayo Clinic between 1992 and 2016. Roughly 42 percent of them had diffuse or vertex scalp thinning. None of the men had eyebrow or body hair loss.
The most common symptom, affecting about 95 percent of the men in the study, was perifollicular erythema (redness around the hair follicle).
The exact cause of LPP is unknown, but some experts think it could be the result of an autoimmune issue.
The most commonly believed explanation is that white blood cells (also called T cells) mistakenly destroy skin and hair cells. One thing known for sure is that lichen planopilaris isn’t contagious.
Though the exact cause of LPP isn’t yet fully understood, several risk factors are associated with developing it:
Autoimmune disorders. LPP is thought to have an autoimmune component, where the immune system mistakenly attacks hair follicles. Folks with other autoimmune diseases, like lupus or thyroid disorders, may have a higher risk.
Genetic predisposition. Some studies suggest a genetic link related to lichen planopilaris, so you might be more susceptible if you have a family history of LPP.
Hormonal changes. Hormonal shifts like those experienced during menopause may trigger or worsen LPP, particularly in women.
Environmental factors. Certain external factors, like UV radiation, stress, or exposure to toxins, might contribute to LPP.
Certain medications. Some medications, including beta-blockers, may increase the risk of getting LPP. Anti-malarial drugs are often used to help control LPP, but there’s some evidence suggesting they can also trigger the condition.
Skin trauma. Some research shows that trauma from a hair transplant or facelift surgery can trigger LPP.
Chronic stress. Long-term stress is considered a potential factor that may contribute to autoimmune responses.
Infections. In rare cases, viral or bacterial infections might trigger an inflammatory response, leading to conditions like LPP.
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If you think you might be experiencing LPP, it’s essential to see a dermatology specialist or another healthcare professional for a diagnosis.
Generally, lichen planopilaris is diagnosed in three steps:
Health and medical history review. Your provider will ask questions about your medical history, lifestyle, and family history.
Physical examination of the scalp. A healthcare professional will look at your scalp for signs of LPP and other forms of dermatitis.
Scalp biopsy. This is a microscopic look at a piece of tissue from the affected area taken through a punch biopsy. A scalp biopsy can confirm LPP while ruling out other conditions.
Making an accurate differential diagnosis is crucial. This means considering other explanations and distinguishing LPP from chronic cutaneous (discoid) lupus erythematosus, alopecia areata, and other types of scarring hair loss.
Ideally, you want to treat LPP as early as possible. Since hair loss is permanent with lichen planopilaris, the earlier you start treating it, the less potential hair loss you’ll 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’re diagnosed with LPP, a healthcare professional may prescribe one of the following lichen planopilaris treatments or medication.
Corticosteroids. Topical or oral corticosteroids can help control inflammation.
Corticosteroid injections. Also called intralesional injections, these injections are made directly into skin lesions.
Antibiotics. This includes doxycycline, which iscommonly prescribed for acne.
Anti-malarial medication. Drugs like hydroxychloroquine can reduce the production of cytokines, small proteins that cause inflammation.
Certain diabetes drugs. Some diabetes medications, including pioglitazone, may help treat LPP.
Immunosuppressive drugs. This includes mycophenolate mofetil and methotrexate.
Retinoids. Retinoids are vitamin A derivatives that regulate skin cell growth and help control inflammation.
Low-level light therapy (LLLT). LLLT uses targeted wavelengths of light to help treat inflammation. One small study found a “reduction of inflammation, disappearance of symptoms, and evident hair regrowth with no side effects” in four patients with LPP.
You might also want to treat the LPP hair loss, which calls for a different course of action from treating the condition itself.
Minoxidil, a topical treatment, may be prescribed by your healthcare provider to encourage hair growth in the affected hair follicles. Exactly how minoxidil works is unknown, but it’s believed to work by stimulating hair follicles to enter the anagen (growth) phase of the hair growth cycle.
Minoxidil comes in two strengths: a 2% concentration and a 5% version. You can buy a 5% minoxidil liquid solution and minoxidil foam online.
Neither topical version of minoxidil requires a prescription, but oral minoxidil is also available off-label in some cases. We offer chewable minoxidil following a virtual consultation with one of our healthcare professionals, who’ll discern if it’s an appropriate treatment option.
LPP can’t be entirely prevented, but there are steps you can take to reduce your risk.
Here’s what can lower your risk of developing LPP hair loss and prevent early lichen planopilaris from worsening:
Early intervention. The earlier LPP is diagnosed and treated, the better the chances of preventing permanent hair loss. Regular check-ups with a dermatologist can help, especially if you have autoimmune conditions or a family history of LPP.
Scalp care. Gentle lichen planus scalp care (avoiding harsh treatments like heat styling, chemical relaxers, or tight hairstyles) can help minimize irritation and inflammation.
Stress management. Reducing stress can also be beneficial, as stress can exacerbate autoimmune conditions. Research (on autoimmune conditions, not specifically LPP) shows that 80 percent of patients report “uncommon emotional stress” before the onset of their autoimmune disease.
Healthy eating and lifestyle. There’s no proven link between LPP and diet, but a healthy lifestyle and an anti-inflammatory diet may support the immune system and overall scalp health.
Though LPP can’t be completely prevented, these steps can help manage the condition and reduce its impact on hair loss.
Research has found that diet can be challenging to study correctly because it’s hard to know how well someone has adhered to their eating plan. Having said that, the Mediterranean diet is known to be anti-inflammatory.
If you suspect you have this type of follicular lichen planus, speak with a healthcare professional as soon as possible to review hair loss treatment options. This will help you minimize patches of hair loss and prevent more from forming.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.
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