Traction Alopecia vs Lichen Planopilaris: Are they easy to confuse?

 Traction alopecia vs LPP: Do they look similar?

 
I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in how traction alopecia and lichen planopilaris might differ

Question

I have one dermatologist who thinks I have traction alopecia and another who thinks I have LPP. Of course, we are going to get a biopsy soon but I’m wondering if they look similar clinically. Aren’t they normally easy to tell apart?

Answer

Thanks for the question.

LPP and traction sometimes look similar.   Most cases of LPP have more defined patches of scarring than traction alopecia and more prevalent perifollicular scaling. In the early stages however, traction and lichen planopilaris can look similar.

Usually, however, they don’t. The one exception is the perifollicular redness that can be seen in both LPP and traction.

 LPP often has scale around hairs and baby hairs (vellus hairs) missing. Traction alopecia usually does not have scale but may have tubes around the hairs higher up (called casts). Traction alopecia usually has lots and lots of baby hairs (vellus hairs) in the early stages.

Here’s a helpful summary:

I am glad to know you’ll have a scalp biopsy soon. Usually an astute pathologist can help sort through challenging cases. Most cases of traction have high numbers of hairs - it’s just many are converted to tiny vellus hairs. Sebaceous glands are present in traction alopecia but lost or reduced in LPP.

Thanks again.