Lichen planopilaris is associated with Inflammation Around Hairs

Lichen planopilaris (LPP) is a type of scarring hair loss that gives permanent hair loss. Scalp biopsies are performed if the diagnosis is still not clear after the physician has examined the scalp.

This photo shows a scalp biopsy from a patient with lichen planopilaris. The skin surface is shown at the top of the picture. Four hair follicles can be seen below that. Inflammation is seen surrounding these hairs. This inflammation promotes the progressive destruction of hair follicles.

Treatments that stop inflammation are often helpful in LPP including topical steroids, steroid injections, topical calcineurin inhibitors, oral doxycycline, oral hydroxychloroquine (Plaquneil), methotrexate, cyclosporine, isotretinoin, mycophenolate ... and others. The goal of treatment is typically to help stop the disease rather than prompt regrowth. That said, the aggressive treatment of LPP in the early stages may help with some amount of regrowth.

Histopathology of lichen planopilaris: Inflammation is seen around the hairs