Lichen Planopilaris: Hair Loss, Scalp Pain, Treatment

Lichen planopilaris (LPP) is a relatively uncommon inflammatory condition that affects the scalp, leading to hair loss and sometimes scalp pain. It belongs to a group of conditions known as cicatricial or scarring alopecia, where inflammation leads to the destruction of hair follicles, resulting in permanent hair loss. LPP typically presents with reddish-brown patches of hair loss and may progress to more widespread balding over time.

Importance of Addressing Hair Loss and Scalp Pain

Hair loss and scalp pain can have significant impacts on an individual’s physical appearance, self-esteem, and overall quality of life. Beyond cosmetic concerns, they can also be indicators of underlying health issues. Addressing these symptoms promptly is crucial for early diagnosis and effective management, improving the chances of preserving existing hair follicles and preventing further damage to the scalp.

Understanding LPP and Exploring Treatment Options

The purpose of this blog is to provide comprehensive information about lichen planopilaris, including its causes, symptoms, diagnosis, and available treatment options. By gaining a deeper understanding of LPP, individuals affected by this condition, as well as their loved ones, can make informed decisions about their healthcare journey.

What is Lichen Planopilaris?

LPP is a chronic inflammatory condition that primarily affects the hair follicles on the scalp, leading to hair loss and scarring. Moreover, it is considered a variant of lichen planus, a skin disorder characterized by itchy, flat-topped, purple-colored bumps. In LPP, the inflammation targets the hair follicles, resulting in their destruction and subsequent hair loss.

Symptoms of LPP may include:

Patchy hair loss, typically with a reddish-brown hue
Scalp tenderness or pain
Itching or burning sensation on the scalp
Scaling or crusting of the scalp
Follicular hyperkeratosis (plugging of hair follicles)
Perifollicular erythema (redness around hair follicles)

Causes and Risk Factors

The exact cause of LPP is not fully comprehended. However, it is believed to involve a combination of genetic predisposition and immune system dysregulation. Certain factors may trigger or exacerbate the condition, including:

Autoimmune disorders: LPP may occur alongside other autoimmune conditions such as lichen planus, lupus erythematosus, or alopecia areata.
Genetic predisposition: A family history of autoimmune diseases or LPP may increase the risk of developing the condition.
Environmental triggers: Exposure to certain environmental factors, such as stress, trauma, or specific medications, may contribute to the development of LPP in susceptible individuals.

Note: There are other conditions that can lead to hair loss, such as Frontal Fibrosing Alopecia.

Diagnosis: How LPP is Diagnosed

Diagnosing lichen planopilaris typically involves a combination of clinical examination, medical history review, and sometimes additional tests. A dermatologist or a healthcare provider specializing in hair disorders may perform the following:

Physical examination: Assessing the scalp for characteristic signs of LPP, such as patchy hair loss, scalp redness, and follicular plugging.
Biopsy: A small sample of scalp tissue may be taken for microscopic examination to confirm the presence of inflammation and scarring around hair follicles.
Blood tests: Although not routinely performed, blood tests may help rule out other conditions or identify underlying autoimmune disorders.

Impact on Quality of Life

LPP can have a significant impact on an individual’s quality of life, both physically and emotionally. Beyond the visible symptoms of hair loss and scalp inflammation, the condition may cause discomfort, pain, and itching, leading to distress and anxiety. The visible changes in appearance may also affect self-esteem, social interactions, and overall well-being. Additionally, the chronic nature of LPP and the potential for progressive hair loss and scarring can create ongoing challenges for individuals living with the condition, necessitating long-term management strategies and support.

Hair Loss and Scalp Pain

Hair loss: Types and Patterns in LPP

The loss of hair in LPP typically follows a distinct pattern that differs from other forms of alopecia. In LPP, hair loss often presents patchy areas of baldness, which may have a reddish-brown hue due to associated inflammation. Unlike some other types of hair loss, such as male pattern baldness or alopecia areata, LPP tends to affect the entire scalp rather than specific areas. As the condition progresses, the affected patches may merge, resulting in more widespread hair loss. Additionally, LPP may lead to scarring of the scalp, making hair regrowth difficult or impossible in affected areas.

Scalp Pain: Nature and Severity

Scalp pain in lichen planopilaris can vary in nature and severity from person to person. Some individuals may experience mild discomfort or tenderness in the affected areas, while others may describe more intense sensations such as burning, itching, or stabbing pains. The scalp pain may be intermittent or persistent and may worsen with certain activities such as washing or styling the hair. In some cases, the pain may be accompanied by inflammation, redness, or sensitivity to touch.

Psychological Effects of Hair Loss and Scalp Pain

The psychological effects of hair loss and scalp pain associated with lichen planopilaris can be profound and multifaceted. Hair loss, in particular, is often closely tied to one’s identity and self-image. So, the visible changes in appearance caused by LPP can lead to feelings of embarrassment, self-consciousness, and low self-esteem. Individuals may also experience anxiety, depression, or social withdrawal as a result of their condition. Especially, if they perceive it as negatively impacting their attractiveness or femininity/masculinity.

The chronic nature of LPP and the uncertainty surrounding its prognosis may further exacerbate these psychological effects. It leads to feelings of frustration, helplessness, and hopelessness. It is essential for individuals living with LPP to receive support not only for the physical symptoms but also for the emotional and psychological toll it may take. Seeking counseling, joining support groups, and connecting with others who understand their experiences can be invaluable in this regard.

Lichen Planopilaris Treatment Options

LPP can be treated at different primary care centers where physicians might prescribe any one of the following lichen planopilaris treatments available to manage the condition:

A. Medications

1. Topical corticosteroids

Topical corticosteroids are often the first-line treatment for LPP. They help reduce inflammation and relieve symptoms such as itching and scalp pain. These medications are applied directly to the affected areas of the scalp and may be available in various forms, such as creams, ointments, or solutions.

2. Oral medications: corticosteroids, retinoids

In cases of more severe or widespread LPP, oral medications may be prescribed. Furthermore, corticosteroids taken orally can help suppress inflammation throughout the body, including the scalp. Retinoids, which are derivatives of vitamin A, may also be used to regulate cell growth and reduce inflammation.

3. Immunomodulators

Immunomodulators may be prescribed to modulate the immune response and reduce inflammation in LPP. These medications are often used as alternatives to corticosteroids, especially in cases where long-term use of corticosteroids is not advisable.

B. Phototherapy

It involves exposing the scalp to ultraviolet (UV) light, which can help suppress the immune response and decrease inflammation in LPP. Additionally, phototherapy may be administered using various techniques. These include narrowband UVB therapy or PUVA (psoralen plus UVA) therapy under the supervision of a dermatologist.

C. Lifestyle Modifications

1. Diet and Nutrition

While there is limited scientific evidence linking diet and LPP, maintaining a balanced diet rich in vitamins, minerals, and antioxidants may support overall scalp health. Some individuals may find that certain dietary changes (reducing inflammatory foods or incorporating more nutrient-dense foods) help improve their symptoms.

2. Stress Management Techniques

Stress has been implicated as a potential trigger for worsening LPP symptoms. Practicing stress management techniques such as meditation, deep breathing exercises, yoga, or mindfulness can help reduce stress levels and improve overall well-being.

D. Surgical Interventions

1. Hair transplantation

Hair transplantation surgery involves removing healthy hair follicles from donor areas of the scalp and transplanting them into bald or thinning areas. While hair transplantation cannot reverse scarring caused by lichen planopilaris, it can help improve the appearance of affected areas and restore hair density.

2. Scalp reduction surgery

Surgeons may recommend scalp reduction surgery for advanced lichen planopilaris cases with significant scalp scarring. During this procedure, they surgically remove the affected areas of scarred scalp tissue and stretch and reposition the surrounding healthy scalp tissue to cover the defect.

Note: Receding hairline is a common clinical presentation for hair loss. However, it is important to understand that it might not be related to LPP or other chronic hair loss disorders.

Conclusion

Living with LPP presents significant challenges, impacting both physical well-being and emotional health. Despite its chronic nature and potential for hair loss and scalp pain, understanding LPP and exploring treatment options offer hope for improved quality of life. Lichen planopilaris treatment ranges from medications and phototherapy to lifestyle adjustments and surgical interventions; there are diverse approaches available.

Moreover, seeking psychological support and building a strong support network can provide essential assistance in coping with the emotional toll of LPP. By raising awareness, advocating for research, and fostering a supportive community, individuals affected by LPP can navigate their journey with resilience and hope for a better tomorrow. At SaadMD, we urge people to schedule an on-site or telemedicine appointment with expert physicians for timely medical intervention.

We hope to see you in person at our locations