Lichen planopilaris up close: A look at "perifollcular scale"

Perifollicular scale: What does this term mean?

Lichen planopilaris ("LPP") is a scarring alopecia which causes permanent hair loss.

Affected individuals frequently develop hair shedding accompanied by scalp itching and sometimes scalp burning and scalp pain.

The accompanying photo shows the typical appearance by trichoscopy of lichen planopilaris (LPP). Single hairs are seen with white scale around these hairs. This whitish scale is known as perifollicular scale and sometimes also as follicular hyperkeratosis.

Treatments for LPP include topical steroids, topical calcineurin inhibitors, steroid injections, oral tetracyclines, oral hydroxychloroquine, oral methotrexate, oral mycophenolate, oral cyclosporine, oral low dose naltrexone. Some patients also respond to oral finasteride.