Lichen Planopilaris: Update on Diagnosis and Treatment

Lichen planopilaris (LPP), a follicular form of lichen planus, is a rare inflammatory lymphocyte
mediated disorder. Although the physiopathology is unclear, an autoimmune etiology is generally
accepted. Women are affected more than men, and the typical age of onset is between
40 and 60 years. LLP is a primary cicatricial alopecia whose diagnosis is supported in the early
stage by both clinical and histopathological findings. Within the margins of the expanding areas
of perifollicular violaceous erythema and acuminate keratotic plugs, the histology can show the
lichenoid perifollicular inflammation. LPP can be subdivided into 3 variants: classic LPP, frontal
fibrosing alopecia (FFA), and Lassueur Graham-Little Piccardi syndrome. With the exception of
FFA, the hairless patches of the scalp can be unique or can occur in multiples and can present
with a reticular pattern or as large areas of scarring. This condition can have major psychological
consequences for the affected patients. The therapeutic management often is quite
challenging, as relapses are common after local or systemic treatments. Further research is
needed on the pathogenesis, and randomized controlled trials of treatment with scientific
evaluation of the results are necessary to appreciate the proposed treatment.
Semin Cutan Med Surg 28:3-10 © 2009 Elsevier Inc. All rights reserved.

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