The Diagnosis and Treatment of Lichen Planopilaris (LPP) Related Hair Loss

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Michael Beehner:

How is [tag]Lichen planopilaris[/tag] diagnosed? Is it just a visual diagnosis or are there tests?

The clinical picture and a biopsy are the usual ways to to diagnose Lichen planopilaris (LPP). It is thought to probably be of an autoimmune etiology. It can sometimes overlap with [tag]Alopecia Areata[/tag] in its clinical appearance, but the [tag]hair loss[/tag] is usually more “splotchy” with multiple, small patches irregularly spread all over the head, including in the donor area. It leaves a “[tag]scarring alopecia[/tag]” result, which means that in each of these little [tag]bald[/tag] patches there are no pores or follicular elements of any sort.

We usually wait at least two years after any sign of disease activity (enlarging, redness, scaling) before considering [tag]hair restoration[/tag] surgery. Some [tag]hair transplant[/tag] surgeons will then perform a repeat biopsy to make sure there are no lymphocytes present around nearby follicles near the edge of these lesions before transplanting. When the diagnosis has already been confirmed before a patient reaches me, I will often give the patient the choice between re-biopsying or doing test grafts. The good news about this diagnosis, as opposed to alopecia areata, is that it often will “burn out” and remain inactive for a long time or for that patient’s life span.

I have transplanted around 10 of these patients and have only had one re-activate. The treatment is steroid injections in the scalp in the area affected. Frontal fibrosing alopecia, which affects mainly the front hairline, beard or eyebrows is thought to be a sub-type of LPP.

Mike Beehner, MD

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
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