As many as 4 in 10 scarring alopecia cases that a dermatologist will see are due to lichen planopilaris, according to some sources. It’s a variation of lichen planus, a condition that causes an itchy skin rash but sometimes affects other parts of the body, such as the mouth, genitals, nails and hair. In cases where lichen planus does affect the scalp it can lead to redness, irritation and permanent hair loss.
What is Lichen Planus?
Lichen planus is not an inherited disease. It is not an infection. It is not related to nutrition. It is not contagious and it is not a form of cancer. Lichen planus is a type of inflammation that develops in the skin but the cause of the inflammation is not known. Most dermatologists believe it is an autoimmune disease, triggered by a virus or other environmental factor which makes the immune system attack the cells on the skin.
Lichen planus commonly appears around the wrists and ankles but it can affect any area of the body. The onset of the rash is usually gradual and it looks like reddish-purple, flat-topped bumps, or sometimes it can have an irregular white lacy appearance called Wickham’s Striae.
What is Lichen Planopilaris?
Lichen planopilaris, also known as lichen planus follicularis, is the specific name given to lichen planus of the scalp. It looks like patches of baldness that may expand and join together over time. The condition develops slowly, but if left untreated, eventually the inflammation will destroy the hair follicles and result in permanent hair loss.
Inflammation is not always present with lichen planopilaris, however, which sometimes makes it hard to distinguish from other forms of scarring hair loss, such as systemic lupus erythematosus and frontal fibrosing alopecia. In these cases a skin biopsy may be required to diagnose the condition.
Who Gets Lichen Planus?
About 1 in 50 people develop lichen planus. It can happen at any age, although more than two-thirds of cases occur in people aged 30 to 60 and it seems to affect women more than men.
People with lichen planus have a slightly higher than average chance of developing other inflammatory diseases, such as alopecia areata, vitiligo and lichen sclerosis. However, most people do not develop any of these conditions.
Treatment for Lichen Planus and Lichen Planopilaris
There is no cure for hair loss as a result of lichen planopilaris and treatment usually involves similar methods used in the treatment of alopecia areata. The most popular treatment methods involve use of corticosteroids. However, their effectiveness varies considerably from person to person. The clinically proven hair growth stimulant minoxidil could possibly help prevent permanent damage to the scalp. It is sometimes used when treating alopecia areata and might help reduce the risk of permanent hair loss by working to stimulate and maintain hair growth.
Similarly, there is no cure for lichen planus. However, about half of all cases affecting the skin clear within six to nine months, and the rest typically last no longer than two years. There is however treatments that can help relieve the itching and improve the appearance of the rash, until it goes away.
- Steroid cream of ointment: work to ease the itch but may not clear the rash
- Steroid pastes or mouth washes: help ease the pain of mouth ulcers
- Steroid tablets: a course of these may clear or greatly reduce the rash but are generally not advised due to possible side-effects. Also, the rash may reappear after the tablets are finished
- Immune suppressant medication: work to reduce inflammation for a variety of conditions but are not usually advised due to potential serious side-effects
- PUVA: light therapy treatment can provide relief but may induce nausea and increase the risk of skin cancer
- Antihistamine medicines: may help ease the itch and help you sleep at night if it is keeping you awake
For information about hair loss and the available treatments, contact The Belgravia Centre on 020 7730 6666. If you would like to arrange a free consultation with a medically-trained specialist at the UK’s leading hair loss clinic, simply call the number mentioned or send an email instead.