Introduction
The scalp is often overlooked or ignored when it comes to overall health and well-being. However, maintaining a healthy scalp is crucial for the condition and appearance of the hair. A healthy scalp provides the foundation for strong, vibrant hair growth while minimizing the risk of various scalp conditions and hair disorders.
What is Lichen Planopilaris?
Lichen planopilaris (LPP) is an uncommon, chronic inflammatory scalp condition that affects hair follicles. It is considered a variant of lichen planus (a skin disorder that can occur in various parts of the body, including the oral cavity). Lichen planopilaris primarily affects the scalp of the individual, leading to scarring of the scalp and hair loss. Although rare, the condition is more common among women than men and in adults aged between forty to sixty years.
What Are the Causes of Lichen Planopilaris?
The exact cause of the development of lichen planopilaris is not known. However, it is believed to be caused by a combination of multiple factors. Lichen planopilaris is widely accepted to be an autoimmune disorder. In the case of lichen planopilaris, the immune system of the individual mistakenly attacks the structure that produces hair, the hair follicle. There are a number of factors that may contribute to the development of lichen planopilaris, including;
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Age - Individuals aged between forty and sixty years are more susceptible.
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Family History - Individuals with a family history of lichen planopilaris are more likely to develop the condition.
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Preexisting Autoimmune Diseases - Individuals with other autoimmune diseases, such as psoriasis (affects the skin) or rheumatoid arthritis (affects the joints), are more likely to develop lichen planopilaris.
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Exposure to Chemical - Individuals who are constantly exposed to harmful chemical substances, such as hair dyes, or environmental chemical exposure, such as arsenic or mercury, have been linked to an increased risk of lichen planopilaris.
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Medications - Studies have shown that prolonged use of certain medications such as beta-blockers, non-steroidal anti-inflammatory drugs (NSAIDs), and antimalarial drugs have been associated with the development of lichen planopilaris.
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Infections - Studies suggest that certain viral or bacterial infections could potentially trigger an immune response in susceptible individuals, leading to the development of lichen planopilaris.
What Are the Symptoms of Lichen Planopilaris?
Lichen planopilaris typically presents with specific signs and symptoms, which may vary among individuals. The most common features of lichen planopilaris include the following:
1. Hair Loss
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Hair thinning.
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Patchy or diffuse hair loss.
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Gradual and progressive hair loss, primarily on the scalp.
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The affected area appears shiny.
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Visible scaling and follicular plugging (abnormal keratin accumulation) is also seen.
2. Scalp Irritation and Itching
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Redness in the affected area of the scalp.
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Itching (may range from mild to severe).
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Inflammation and tenderness of the scalp.
3. Scarring Alopecia: Over time, lichen planopilaris can cause permanent scarring of the affected hair follicle.
How to Diagnose Lichen Planopilaris?
Diagnosis of lichen planopilaris requires a comprehensive evaluation of medical history, physical examination, and laboratory tests.
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Medical History - The doctor will enquire if anyone in the family has experienced a similar condition or if the individual is known to have any other autoimmune conditions. History of any possible exposure to harmful chemicals directly to the scalp will also be considered. Medical history is also evaluated to rule out other possible reasons for hair loss.
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Physical Examination - The dermatologist will examine the condition of the hair and the health of the scalp. The areas of hair loss are also closely examined.
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Trichoscopy - It is a form of dermoscopy specifically designed for the diagnosis of hair-related conditions. This is a technique that utilizes magnification and a light source to perform a detailed examination of the scalp and hair.
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Biopsy - A quarter-inch deep tissue of the affected area of the scalp is excised using punch biopsy. This excised specimen is sent to the laboratory for further examination. In the case of lichen planopilaris, lymphocytic inflammation, fibrosis, and destruction of the hair follicular structure are observed.
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Additional Tests - In some cases, additional tests may be performed to rule out other possible conditions and to assess the extent of the disease condition. These may include blood tests to check for autoimmune markers, such as antinuclear antibodies (ANA), erythrocyte sedimentation rate (ESR), or any other specific antibodies associated with autoimmune diseases.
How Is Lichen Planopilaris Treated?
Although there is no cure for lichen planopilaris, various treatment approaches aim to manage the symptoms, slow down hair loss and prevent scarring. The choice of treatment depends on the severity of the condition and individual health factors. Common treatment options include:
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Topical Medication - Corticosteroid creams or ointments are commonly prescribed to reduce inflammation and itching. These medications are typically applied directly to the affected scalp areas.
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Intralesional Corticosteroid Injections - For more localized and stubborn areas of inflammation, the dermatologist may administer corticosteroid injections directly into the affected scalp patches. This targeted approach can help reduce inflammation and promote hair regrowth in those areas.
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Topical Calcineurin Inhibitors - Tacrolimus (0.3 percent) or Pimecrolimus are calcineurin inhibitors that help modulate the immune response and reduce inflammation. These may be prescribed as alternatives to corticosteroids or as a combination therapy.
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Oral Medications - In severe cases or when other treatments are not quite effective, systemic corticosteroids may be prescribed. However, these medications are generally used for a short period of time due to their potential to cause adverse side effects.
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Phototherapy - Light therapy, such as narrowband ultraviolet B (NB-UVB) or excimer laser, may be used to reduce inflammation and promote hair regrowth. These treatments require regular sessions and are typically performed under the supervision of a dermatologist.
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Hair Transplantation - In advanced cases with extensive scarring and permanent hair loss, hair transplantation may be recommended to restore hair in the affected areas. This procedure involves transplanting healthy hair follicles from other parts of the scalp to the affected areas.
Conclusion
Lichen planopilaris is a chronic autoimmune scalp condition that causes scarring and hair loss. While the damage could be permanent, early diagnosis and appropriate treatment measures can help individuals manage the symptoms, slow down the hair loss process and subsequently reduce scarring of the scalp. Protecting the scalp and hair against harmful chemicals may also help prevent the development of lichen planopilaris.
