Scarring hair loss results when an inflammatory skin condition destroys the hair follicle and replaces it with scar. Lichen planopilaris is a type of scarring hair loss that occurs when the inflammatory skin condition known as lichen planus, affects areas of skin where there is hair. The result is patchy hair loss. This condition is most common in white women in their mid-forties.
Lichen planopilaris most commonly affects the top of the scalp. The most common symptom is intense itching but pain, burning and scalp tenderness may be present. Tiny red bumps and scaling may appear around clusters of hairs giving the scalp a rough texture. Gradually, patches of hair are lost and affected areas may appear smooth and shiny. While the scalp is most often involved, face and body hair may rarely be affected.
A recently described form of lichen planopilaris is called frontal fibrosing alopecia. This condition is most commonly seen in post-menopausal women. This appears as a band of hair loss affecting the front hairline and temples. Loss of eyebrow hair is frequently present and may be the first sign of frontal fibrosing alopecia.
The cause of lichen planopilaris is unknown but it is likely to be linked to the body’s immune system. White blood cells attack and destroy cells of the hair follicle. The triggers for this attack are unknown. This condition is not infectious or inherited. However, there may be genes which increase the risk of developing the disease.
Lichen planopilaris is 2-5 times more common in women than in men and is seen mostly in white adults in their mid-40’s.
Dermatologists will often suspect lichen planopilaris based on the physical exam; however, a skin biopsy is usually necessary to confirm the diagnosis. A biopsy is the removal of a small piece of scalp skin for examination under a microscope. A dermatologist can quickly and safely perform a biopsy during an office visit.
There is no single proven effective treatment for lichen planopilaris and despite trying a variety of medications, some people will not improve. Success rates are variable.
Treatments that have been used include the following:
In most cases, lichen planopilaris will eventually become inactive. However, hair loss that has occurred will be permanent. Treatments used may help to maintain the remaining hair and control symptoms but will not lead to regrowth of previously lost hair. Cosmetic aids such as tinted powders, lotions and hair fiber sprays can all provide camouflage in areas of hair loss. Wigs and hair pieces can be used to cover balding areas. Advances in the technology of these have made their use more acceptable.
The emotional aspects of living with hair loss can be significant. If your hair loss bothers you a lot, you may wish to join a support group such as the Cicatricial Alopecia Research Foundation.