Perifollicular scale in Lichen Planopilaris (LPP): Close Association with Disease Activity

The Scale in Lichen Planopilaris

Dermoscopy also called trichoscopy is extremely helpful to the proper evaluation and management of hair disorders. Hand held dermatoscopes not only help in making correct diagnoses but help in monitoring disease activity. I need my dermatoscope to properly do my job.

Perifollicular scale (scale around follicles) is one dermatoscopic feature of lichen planopilaris and frontal fibrosing alopecia. Identifying the amount of scale is important as such scaling correlates nicely with the amount of inflammation going on under the scalp as well as correlating with the so called lichen planopilaris activity index (LPPAI). The presence of perifolliclar scale in patients with LPP is not ideal as it means the patient is at significant risk to lose hair.

Reference 

Lajevardi V, et al. Assessing the correlation between trichoscopic features in lichen planopilaris and lichen planopilaris activity index. Australas J Dermatol. 2019