Lichen Planopilaris

Diagnosis: Lichen Planopilaris

Reddish scaly patches of alopecia that represent still active lesions.

Clinical Presentation

Reddish scaly patches of alopecia that represent still active lesions.

Clinical History

Submitted by Alaa Saad. Originally posted September 14, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Discoid lupus erythematosus • Central centrifugal cicatricial alopecia • Frontal fibrosing alopecia • Alopecia areata • Tinea capitis • Folliculitis decalvans

Key Learnings

• Primary lymphocytic cicatricial (scarring) alopecia — follicular variant of lichen planus • Classic triad: perifollicular erythema, perifollicular scale, loss of follicular ostia (scarring) • Pull test positive at active margins • Frontal fibrosing alopecia (FFA) is now considered a variant — progressive frontotemporal hairline recession • Early treatment is critical — once scarring occurs, hair loss is permanent • Biopsy from active margin showing lichenoid interface dermatitis targeting follicular epithelium

Tags: lichen, planopilaris, alaa saad