What is Lichen Planopilaris?
Are you losing hair and can’t figure out why?
You may have lichen planopilaris, an inflammatory condition that affects the hair follicles on your head. This condition affects women at higher rates than men and typically presents in adulthood.
Hair loss can be mentally distressing and negatively impact your quality of life. Fortunately, there are options to minimise this psychological impact and improve your symptoms.
If you are suffering from lichen planopilaris, you can seek treatment in Mumbai from the Malay Mehta Aesthetic Clinic. We offer services such as hair transplant, hair reconstruction, and hair growth enhancement for men and women to treat lichen planopilaris in Mumbai, India. Book a consultation online or call +91-7045291747 to start your treatment journey today.
Lichen planopilaris is a scalp condition presenting as smooth patches of hair loss, where no hair follicles are visible. These patches are usually surrounded by scaly and red skin, and nearby hairs are easily pulled out. The exact cause of this disease is yet to be determined, however, it is commonly thought to be a variant of lichen planus. The clinical features of this condition are largely consistent across skin types.
Alongside the smooth hairless patches, patients may also experience itching, burning, tenderness, discomfort, and pain in the affected region. The primary complications of this condition are hair loss as well as eyelash and eyebrow loss, and importantly the associated psychological effects.
This condition generally affects middle-aged women, however, it can affect anyone. It is commonly associated with lichen planus, a chronic inflammatory disease of the skin and mucosae.
Lichen planus is an auto-immune disorder mediated by T-cells where immune cells target a protein in keratinocytes in the skin and mucous membranes. This can develop due to a genetic predisposition, stress, injury (such as cuts, abrasion, or surgery), herpes zoster disease, systemic viral infections (e.g. hepatitis C), contact allergies, or drugs. There are a variety of other conditions associated with lichen planus.
Types of Lichen Planopilaris
There are three main categories of this condition: classic, frontal fibrosing alopecia and Lassueur Graham-Little Piccardi Syndrome.
Classic Lichen Planopilaris
The classic type of this condition is also referred to as follicular lichen planus and presents with smooth, white patches of hair loss on the scalp. These patches are typically surrounded by red and scaly skin.
Frontal Fibrosing Alopecia
Frontal fibrosing alopecia (FFA) is a variant that affects the frontal scalp area and eyebrows. Diagnosing FFA involves the detection of isolated terminal hairs in the frontal scalp, as well as chronic cutaneous lupus erythematosus and skin biopsy.
Lassueur Graham-Little Piccardi Syndrome
Lassueur Graham-Little Piccardi syndrome is a rare variant characterised by progressively worsening patchy hair loss on the scalp associated with scarring, thinning of armpit and pubic hair without scarring, and spiky bumps on hair follicles. It is not uncommon to have a complete loss of hair in the armpit and groin. Lassueur Graham-Little Piccardi syndrome is officially diagnosed when all three of these clinical features are present, as well as a scalp biopsy.
Hair is lost in this disease because the immune cells of the body target hair follicles. Destruction of hair follicles leads to hair fall and can result in scarring in the area. This causes patchy hair loss and loss of hair follicles within the patches themselves.
When do symptoms of this disease begin?
While anyone can be affected by this condition at any age, symptoms of lichen planus are most likely to manifest in adult life, between the ages of 19-65.
Differential diagnosis for Lichen Planopilaris
Lichen planopilaris shares symptoms with a number of other related conditions, which it can sometimes be mistaken for. This is known as a differential diagnosis, and similar conditions include
Discoid lupus erythematosus (DLE)
DLE is the most common form of cutaneous lupus, and a sub-type of chronic cutaneous lupus erythematosus. Characteristic features of DLE include scaly patches on the scalp, face, and ears, which commonly lead to scarring, hair loss, and dyspigmentation.
Central centrifugal cicatricial alopecia (CCCA)
CCCA is a scarring variant of alopecia leading to permanent loss of hair. It is highly prevalent in black women but can affect anyone. Patients present with mid-scalp balding extending outward. Hair follicles are typically not seen in hairless areas, making the scalp look shiny.
Folliculitis decalvans is a chronic condition associated with neutrophilic inflammation, typically affecting males in their 40’s-50’s. Patients present with white patches of scarring hair loss on the scalp as well as induration, formation of follicular pustules and crusts around the patch, hyperkeratosis of the hair follicles, as well as itching, pain, or discomfort.
Alopecia areata is an autoimmune disease affecting the hair follicles, leading to hair loss predominantly on the scalp. Alopecia affects people of all ages and all ethnicities.
Pseudopelade of Brocq
Pseudopelade of Brocq is a form of scalp baldness with an unknown cause. Patients present with small patches of hairlessness beginning at the highest point of the scalp. Patches can be found singularly or in multiples, they are often smooth and soft, round or oval in shape, not scaly, and skin-coloured.
How is Lichen Planopilaris diagnosed?
Diagnosis of lichen planopilaris is achieved by a combination of clinical features, including patchy hair loss, lack of hair follicles in patches, redness and scale surrounding patches, itching, burning, and pain in the scalp, and microscopic analysis of a sample of tissue from the affected area.
Hair loss due to lichen planopilaris can be very distressing.
Treatment should be started early, as hair cannot be regrown over scar tissue. Lichen planopilaris treatment in Mumbai is designed to slow disease progression and improve symptoms. Examples of anti-inflammatory treatment options include topical, intralesional, or oral corticosteroids, topical tacrolimus or minoxidil, hydroxychloroquine, tetracycline, ciclosporin, or methotrexate.
Other non-pharmacological methods include hair colouring, strategic hair styling, or the use of hairpieces to improve the self-esteem of the patient. Scalp reduction or hair transplant surgery is also an option in end-stage diseases with large scarred areas.
The outcome of Lichen Planopilaris
Disease prognosis cannot be predicted for this condition, particularly as the response to treatment is very variable among patients. In some cases, it can improve on its own, but in other cases, it can progressively worsen.
How Much Does Lichen Planopilaris Treatment Cost?
Treatment of lichen planopilaris in Mumbai will differ depending on the type of treatment. Conservative approaches cost a lot less than invasive approaches. For the best estimate of the cost of your treatment, we recommend that you book an appointment with Dr Mehta to determine your personalised treatment.
Dr Mehta offers a wealth of knowledge and experience in hair loss treatment. To help treat this condition, Dr Mehta can prescribe topical minoxidil, which is applied to the scalp twice daily. This has been shown to improve hair growth in as little as three months. Dr Mehta can also use laser therapy to stimulate hair growth, or mesotherapy involving subcutaneous injection of stimulating nutrients directly to the scalp. In severe cases, Dr Mehta can also offer lichen planopilaris hair transplant in Mumbai.
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Frequently Asked Questions
Lichen planopilaris is a hair-loss condition that can be distressing. Find answers to frequently asked questions below:
Lichen planus affecting the hair follicles is thought to be a cause of this condition. It is characterised by patchy hairlessness predominantly on the scalp accompanied by itching, burning, pain, and discomfort.
Patients present with smooth, white patches of hair loss on their scalp, typically red and scaly at the edges.
In some cases, lichen planopilaris can improve on its own, but in other cases, it will get progressively worse. Treatment should be started early to slow the progression of the disease and relieve symptoms.
Fatigue can be a symptom of lichen planus. Ask your doctor if you are concerned.
Lichen planopilaris can cause permanent hair loss. While it is typically patchy, if left untreated, it is possible that all hair on the scalp can be lost as the disease progresses.
While the exact cause remains unknown, it is thought that lichen planopilaris is an autoimmune disease where immune cells attack the hair follicles.
There is some evidence to suggest that there may be an influence of genetic predisposition to developing this condition. This familial component is not yet well established.
There is no cure at this time. Treatment measures aim to relieve symptoms and slow the progression of the disease, but a cure has yet to be determined.
This usually results in permanent hair loss. Hair cannot regrow in areas that have scarred over. Treatment options aim to slow the progression of the disease and improve overall hair thickness, but hair regrowth in scarred areas is not possible.