Lichen planopilaris: Shedding, Itching, Burning, Tenderness

Shedding, Itching, Burning, Tenderness

Lichen planopilaris (“LPP” for short) is a type of hair loss that is categorized as a type of so called scarring alopecia.

There is no single way that LPP first announces its presence. Some people have only scalp itching. Some have burning. Some have itching and burning along with a bruised-like tenderness in the scalp. Surprisingly, a small proportion of patients with LPP have no symptoms at all.

Many patients notice they are shedding more hairs on a daily basis than they once did.

Eventually, some patients develop an area of hair loss on the scalp that concerns them and brings them to the doctor.

In many cases the diagnosis can be determined by simply looking at the scalp but often a biopsy is performed to confirm the diagnosis. A biopsy shows the presence of both inflammation beneath the scalp (in a specfic pattern) as well as scar tissue (fibrosis). Treatments include topical steroids, topical calcineurin inhibitors, steroid injections, and a variety of oral medications (doxycycline, hydroxychloroquine, methotrexate, cyclosporine, mycophenolate, isotretinoin, low level laser, excimer laser, tofacitinib).