Stress and Lichen Planopilaris (LPP): Did stress cause my LPP?
Stress and LPP
Patients often ask me if stress caused their scarring alopecia. In the present day and age, it seems that stress does not cause scarring alopecia but can certainly contribute to it being more active and flaring when it might otherwise be quiet.
An Analogy
As many of my patients know, I often use analogies in the clinic. Analogies are helpful means of thinking about otherwise complex or abstract topics in simpler ways.
Does stress cause scarring alopecia? Well, let consider as an analogy two campers that are camping in the wilderness in the middle of the Summer. It’s been a dry summer and there are signs posted everywhere not to build a campfire because of the concern that it could cause a forest fire. After returning from a long hike, one of the campers decides that he wishes to have a cigarette and proceeds to light and smoke the cigarette. Twenty minutes later both campters realize that somehow the cigarette has caused the nearby underbrush to catch on fire and there is now a small forest fire happening.
The forest rangers and firefighters are called in to put on the fire. During the conversation, one of the campers makes a comment that all this dry weather caused the fire.
Did the dry weather cause the fire? No, not at all. An improperly disposed of cigarette caused the fire. The dry weather did not cause the fire but certainly the dry weather contributed to the fire developing more easily and spreading more rapidly.
Now back to the role of stress in scarring alopecia. The cigarette is like the immune system and the dry weather is like stress. It is the aberrant immune system activation that causes the LPP just like the aberrantly disposed of cigarette causes the forest fire. The dry weather makes the fire flare when it might otherwise have just extinguished itself just liek stress causes the LPP to flare when it might otherwise have just stayed quiet.
Stress can contribute to a scarring alopecia becoming more active and contribute to flares but probably is not an underlying cause. In my experience, some conditions (like frontal fibrosing alopecia) seem to have a greater contribution from stress than other conditions (like folliculitis decalvans) The exact reason for this is not clear.
Articles of Interest
Interested Readers may wish to see previous articles by Dr. Donovan
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.