Diseases on Hair Follicles Leading to Hair Loss Part II: Scarring Alopecias

Katharina Wiedemeyer; Wolf-Berhard Schill, MD; Christoph Löser, MD


Skinmed. 2004;3(5) 

In This Article

Lichen Planopilaris

Lichen planopilaris, also called lichen ruber follicularis, evokes perifollicular erythema and sometimes hyperkeratotic follicular papules. A violaceous discoloration of the scalp may be observed. It typically starts with small spotted hairless areas in the vertex region that may confluence to broad patches. These do not show any noticeable pathology apart from missing follicular orifices (Figure 2). Middle-aged women are affected preferentially.

Alopecia caused by lichen planopilaris. Mainly in the vertex region, irregular shaped hairless patches without any further visible pathology are found; follicle orifices are missing.

Sometimes, examination of the nails, mucous membranes, and the whole integument may give further evidence for lichen planus. If alopecia is the only symptom it is difficult to distinguish between cutaneous lupus erythematosus and lichen planopilaris.[9]

Typical pathohistologic findings of lichen planopilaris are vacuolar degeneration of the basal cell layer and lichenoid infiltrates along the epidermis and around the follicular epithelium. The infiltrates mainly consist of lymphocytes and histiocytes. In residual lesions, burnt-out interfollicular fibrotic strands are the main characteristics.

Topical or systemic corticosteroids, retinoids, or psoralen-UV-A therapy are the treatments usually proposed.[10] But there are also reports about effective treatment with cyclosporin A in more severe forms of lichen planopilaris such as the Graham Little-Piccardi-Lassueur syndrome.[10] Antimalarials and thalidomide are other alternatives in Lichen planopilaris.[11]


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