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Hair loss can be caused by a multitude of reasons. For some people, it can be attributed to genetic factors [1], and for others, it could be temporary hair loss caused by a particularly stressful event in your life.
Another reason that people can start to lose their hair is as a result of another medical condition like Lichen Planopilaris (LPP).
Lichen Planopilaris, which can also be referred to as lichen planus, is a type of skin disease that affects any part of the body where you have hair [2]. This condition can often cause permanent hair loss by destroying individual hair follicles and leaving scarring behind.
Although there is limited data on the amount of Lichen Planopilaris cases worldwide, the condition is thought to affect less than 1% of the world’s population [3]. It’s also been observed that the condition is more common in women than men, particularly those aged between 40–60 [4].
In the US, 142 individuals out of 327,654 participants had LPP, representing a prevalence of 0.0043%, with the average diagnosis being 62.4 years [5].
It’s important for us to understand the causes and treatment options of Lichen Planopilaris as the sooner you spot the early symptoms, the sooner you can treat lichen planopilaris and prevent permanent hair loss. Keep on reading below to find out more about the skin condition.
What are the different types of Lichen Planopilaris?
There are three types of this skin condition that can cause scarring to the scalp:
- Classic LPP
- Frontal Fibrosing Alopecia
- Lassueur Graham-Little Piccardi Syndrome.
Classic Lichen Planopilaris (Follicular lichen planus)
This is the typical version of the skin condition that destroys hair follicles and leads to scarring alopecia (aka scarring hair loss).
Lassueur Graham-Little Piccardi Syndrome
A condition that is most common in women, this condition leads to patchy hair loss, thinning hair on the armpits and groin, as well as rough bumps around hair follicles.
Frontal Fibrosing Alopecia
Frontal Fibrosing Alopecia (FFA) is a type of LPP that commonly affects the eyebrows, eyelashes, and hair around the forehead. This condition will often appear as progressive hair loss that happens slowly.
What causes Lichen Planopilaris?
The causes of Lichen Planopliaris are still unknown however, experts believe that these skin diseases are linked to autoimmune conditions.
It is thought that when someone is suffering from LPP, the immune system is mistakenly attacking healthy tissues, like hair follicles. This is similar to alopecia areata, a hair loss condition characterised by patchy hair loss caused by the immune system attacking hair follicles. However, unlike alopecia areata, Lichen Planopilaris results in scarring hair loss whereas alopecia areata does not.
Studies have shown that LPP can often occur in patients who have chronic inflammatory or autoimmune diseases, with patients with the skin condition showing a higher prevalence of autoimmune diseases and thyroid abnormalities compared to the normal population [5].
Is Lichen Planopilaris hereditary?
No, this condition is not thought to be inherited. Patients may have a genetic predisposition to the condition based on the genes that affect their immune system which can increase their risk of developing LPP.
LPP is also not contagious, so it’s not possible for someone to spread it to others.
Symptoms of Lichen Planopilaris
No two patients of LPP are the same. It’s very common for people to respond to the condition differently, which can make it present itself in very different ways.
Some of the common symptoms that you should look out for include:
- Redness on the scalp, or areas where hair grows
- Patchy baldness where no hair follicle openings can be seen
- Red and inflamed scaly patches of hair loss
- Pain around the scalp, and other areas where hair grows
- Itchiness of the scalp, and in other areas where hair grows
For some patients, these symptoms can appear quickly and for others, they can come on gradually over time. Diffuse hair loss (hair thinning) is not usually a symptom of lichen planopilaris.
What triggers Lichen Planopilaris?
Since the cause of Lichen Planopilaris is still unknown, it’s hard to say if there is anything in particular that triggers the condition.
For some forms of scalp hair loss, like telogen effluvium, stress can be a large trigger of balding. However, this doesn’t seem to be the case for patients with LPP and it may all come down to genetics.
How medical experts diagnose Lichen Planopilaris
The first step to treating any condition is getting a proper diagnosis. There are many different conditions that can lead to hair loss that may present themselves in similar ways but require very different treatments.
We recommend visiting your GP first. They will be able to look at your scalp and perform a physical examination of the scalp to determine if you are suffering from Lichen Planopilaris, or if it is another condition.
They may ask you about the medications you take, if you have a history of health conditions in your family, or they may refer you to a specialist in order to get a second opinion.
After this initial consultation, you may have to get additional tests to reach a diagnosis. These tests could include a:
- A scalp biopsy. This procedure involves removing a small section of skin from your scalp and sending it to a laboratory for further analysis.
- Dermoscopy. This procedure involves looking at your scalp through a magnifying device to see if there are any signs of patchy hair loss or scarring.
Treatment options for Lichen Planopilaris
Unlike other forms of hair loss, balding is permanent for those who suffer from LPP. However, if you are able to detect the condition early on before you experience severe hair loss, you can start treatment to prevent further hair loss.
Unfortunately, LPP is not a condition that will go away on its own. Fortunately, there are some treatments that you can try, including anti-inflammatory medication as well as topical, oral, and surgical treatments.
Anti-inflammatory medication
One of the main treatments that you get prescribed is some sort of anti-inflammatory medication like topical corticosteroids, oral corticosteroids, corticosteroid injections, and anti-malarial medication like hydroxychloroquine or retinoids.
Topical treatments
A popular treatment that is well-tolerated by both men and women who experience hair loss is Minoxidil. This product comes in both a topical and oral treatment, usually under the brand names Rogaine or Regaine.
For this topical treatment, you will be advised to apply it to areas where you’re experiencing hair loss twice a day every day. This treatment will not prevent hair loss overnight, but after a few months of consistent usage, the results of this treatment are very positive.
Minoxidil works by encouraging hair follicles to enter the anagen (growth) phase of the hair growth cycle. Because this treatment does take a few months to show any results, it’s especially important for patients with LPP to start treatment as early as possible.
Oral treatments for Lichen Planopilaris
Finasteride and Dutasteride are two hair loss treatments that you’ve probably heard of if you’ve already done some research into treatments.
Although these two treatments show very promising results, they are unlikely to work on patients suffering from LPP.
Both of these oral treatments work by blocking DHT, a hormone that is a common cause of male pattern baldness. However, DHT is not the case of LPP which can prevent these treatments from having any form of positive effect.
Surgical options for Lichen Planopilaris
If you have already lost all the hair on your head as a result of LPP, it is probably too late for any of the above treatments to work – they may show positive results on some patients, but not those who have permanent hair loss from LPP.
Surgical options, like hair transplantation, are a good option for those who want to have a full head of hair again. When the process is carried out by a professional practitioner, like our team at Wimpole Clinic, you will be able to enjoy a natural result that will look like your hair miraculously grew back.
At Wimpole Clinic, we offer two popular forms of hair transplants; FUE (Follicular Unit Extraction) transplants and FUT (Follicular Unit Transplantation). The two treatments are quite different so we would recommend doing your research before taking the plunge.
If you’d like to find out more about the process of getting a hair transplant, you can schedule a free consultation with one of our experts. They’ll be able to talk you through the entire process and make sure you achieve the luscious locks you’ve always wanted.
Living with Lichen Planopilaris
Losing all of your hair can have a big impact on your mental well-being. We often don’t realize how much of an important role our hair plays in our confidence until we find ourselves without it.
It’s important to find ways to cope with the emotional and psychological impact of Lichen Planopilaris. For some people this will involve focusing on self-care and being easy on themselves, for others, it can involve reaching out to healthcare professionals and learning more about their condition.
While your hair is falling out, you can try out different hairstyles, be mindful of the products and tools you’re using on your hair, and try to maintain a healthy lifestyle to prevent any other negative effects.
If you’d like to find out more about the support and resources that are available for individuals suffering from Lichen Planopliaris, you can visit the following resources:
- https://www.bad.org.uk/pils/lichen-planopilaris/
- https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/lichen-planus
- https://www.alopecia.org.uk/
The Wimpole Clinic offers FUE Hair, Beard & Eyebrow Transplants & Trichology.
Talk to a specialist ☎ 020 7935 1861.
Talk to a specialist ☎ 020 7935 1861.
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