Clues to the Early Diagnosis of LPP

Early LPP Diagnosis May be Challenging

Lichen planopilaris (LPP) is a type of scarring alopecia. It affects both men and women and typically those 30-60 years of age. The diagnosis becomes easier over time for any given patient given that time may allow certain characteristics to develop around hairs (ie perifollicular scale or perifollicular redness) and time may also allow areas of hair loss to develop on the scalp.

The earliest stages of LPP are more challenging to correctly identify. The early diagnosis is, however, quite important to reduce the progression of the hair loss. In addition, this is the stage at which some amount of improvement might still be possible with aggressive treatment. A few key concepts will allow the astute physician to pick up on clues that will them prompt a scalp biopsy (which can then potentially help rule in or rule out the diagnosis). These clues include (1) reports by the patient of itching of the scalp along with burning or tenderness (2) redness in the scalp along with excessive shedding. For many patients, LPP declares its presence with unpleasant symptoms along with increased shedding of hair. It can mimic seborrheic dermatitis almost perfectly as it did in this patient shown here.