Videodermoscopy of Lichen Planopiliaris

LPP Videodermoscopy (Trichoscopy)

Videodermoscopy (trichoscopy) of lichen planopilaris. The patient presents with increased hair shedding thought initially to be related to a stressful life event. There is associated itching in the scalp and burning that can not seem to settle. Examination here shows redness in the scalp as well as scale around hairs (perifollicular scale). There as some hairs missing in areas which is typical of the scarring patches this disease creates. Most hair follicles are the same size (caliber) indicating the degree of miniaturization is minor and that androgenetic alopecia is not a feature here.

Treatments started with topical clobetasol daily followed by a plan to taper the dose. Steroid injections with triamcinolone acetonide were performed with 2.5 mg per mL with 10 mL and 75 injections throughout the scalp. Hydroxychloroquine was started a dose that corresponds to the patient’s weight. Doxycycline was considered but a decision was made in favour of hydroxychloroquine given the patient’s gastrointestinal issues and long hours of outdoor work that might make the photosensitizing potential of doxycycline more challenging. The patient will be seen back in 3-4 months. Blood tests will be needed monthly while on hydroxychloroquine for three months (CBC, AST, ALT). An eye examination is needed for all patients starting hydroxychloroquine and periodically thereafter. Blood tests were already done for thyroid and vitamin D status and given the associated low vitamin D the patient was started on 3,000 IU daily.