Tubular Scaling in Lichen Planopilaris (LPP)

Tubular Scaling May be seen in at Least 25 % of Lichen Planopilaris

Scaling around hairs occurs in a number of disorders. When the scaling hugs or surrounds the hair shaft, it is often referred to as perifollicular scaling. When scaling not only surrounds the hairs but also climbs up the hair shaft such that the length of the scaling is greater than the width, the term ‘tubular scaling’ is used. Tubular scaling is is a type of proximal hair cast. Hair casts are cylindrical structures seen surrounding hairs. A variety of inflammatory disorders can give tubular casts.

This photo shows an example of a proximal tubular hair cast or tubular scaling

Trichoscopic image showing tubular scaling (arrow) in a patient with lichen planopilaris.

In 2019, Mathur and colleagues set out to better understand some of the causes of tubular hair casts. The authors noted a variety of different patterns of tubular casts in inflammatory hair disorders - and 90% were proximal casts just like shown in the photo above. In total, tubular casts were noted in 50 % of pemphigus vulgaris, 30 % of frontal fibrosing alopecia, 26 % of discoid lupus, 25 % of lichen planopilaris, 20 % of pemphigus folliaceus and 17% of tinea capitis. (in this study common disorders with tubular casts were excluded such as seborrheic dermatitis, psoriasis, traction and trichotillomania).

See Prior Article: Tubular Hair Casts: A Closer Look

Scaling in Lichen planopilaris

There were 16 patients with LPP in the author’s study. Tubular hair casts were found in 4 patients or 25%. Scaling was proximal in 75 % of those patients noted to have casts and both proximal and distal in 1 patient. In all 4 patients, there was just one cast noted on a hair and only one hair was ever enveloped by a cast. The surrounding scaling of the scalp skin was minimal to absent in all 4.

REFERENCE

Mathur  M et al. Tubular Hair Casts in Trichoscopy of Hair and Scalp Disorders. Int J Trichology 2019 Jan-Feb;11(1):14-19.

https://donovanmedical.com/hair-blog/tubular-hair-casts