WHAT IS LICHEN PLANOPILARIS?Lichen planopilarisis a disease of the hair, primarily the scalp, but the eyebrows can also be affected. An inflammatory reaction develops around the hair follicles, damaging them and causing the hair to fall out. This inflammatory reaction eventually destroys all the hair follicles, leaving only scar tissue. The hair does not grow back. It occurs primarily in women between the ages of 40 and 60; it is less common in men.WHAT CAUSES LICHEN PLANOPILARIS?The cause is unknown. What is clear is that there is an abnormal immune system response. Immune cells attack the hair follicles, even though there is no reason for this, and ultimately destroy them completely. Often, the inflammatory response is not limited to the hair follicles alone, but also causes skin lesions, mucosal lesions, and nail lesions. This is called lichen planus .WHAT ARE THE PHENOMENA?Gradually, more and more bald patches appear on the scalp. It often starts in the center of the scalp and spreads to the edges. But it can occur anywhere on the scalp. Eyebrows can also fall out, often starting at the outer edges. In the active phase of the disease, the affected areas may itch or feel like burning. Small reddish-brown bumps and scales may also be visible around the hairs. In later stages, scarring of the hair follicles occurs. Eventually, completely bald patches develop, with no visible follicle opening. Sometimes a few hairs remain. The speed at which this process progresses varies from person to person, and the course is unpredictable.
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Approximately 20-50% of patients also have lichen planus of the skin (red or reddish-brown raised bumps, especially around the wrists), or of the mucous membranes (white, reticulated, streaky lesions in the oral cavity), or nail abnormalities (thickening, grooves, cracks, nail loss).
There is also a variant of lichen planopilaris in which only the front hairline recedes. This variant is called frontal fibrosing alopecia . Frontal fibrosing alopecia progresses slowly. It often begins with eyebrow loss. Eventually, the hair loss along the front hairline becomes visible, as a lighter strip of skin appears, showing no signs of sun damage. Sometimes a single hair remains in this area; this is called "lonely hairs." See frontal fibrosing alopecia for more information .HOW IS THE DIAGNOSIS MADE?The diagnosis is based on the clinical picture, i.e., its appearance. The dermatologist can usually make the diagnosis by carefully examining the skin around the hair follicles with a dermatoscope, a magnifying glass with special lighting. If the image is not entirely clear, a skin biopsy may be necessary . A small piece of skin is then removed under local anesthesia and sent to the pathology laboratory.HOW CAN LICHEN PLANOPILARIS BE TREATED?Lichen planopilaris is difficult to treat. Once hair follicle loss with scarring has occurred, it is irreversible. However, if treatment is started early, there is still a chance of hair regrowth. Treatments are aimed at preventing or slowing further hair loss and reducing itching and burning. Lichen planopilaris is treated with anti-inflammatory medications . These can be lotions or creams applied to the scalp ( topical therapy ), or tablets or capsules taken orally ( systemic therapy) . Topical and systemic treatments can also be combined.
Topical therapy:
Usually, topical corticosteroid lotions for the scalp, such as Topicorte lotion, Betnelan lotion, Diprosone lotion, Elocon lotion, Locoid scalp lotion, Dermovate lotion, Clarelux foam, or Clobex shampoo, are used. Alternatives include tacrolimus ointment or pimecrolimus cream. These products do not contain corticosteroids, but are slightly less potent and the base is not as suitable for hairy scalps. Some pharmacies in the Netherlands can make tacrolimus lotion, but this is not covered by insurance.
Systemic therapy:
If local treatment is insufficiently effective, or if the condition progresses rapidly, systemic anti-inflammatory therapy in the form of tablets or capsules can also be used. The most commonly used medications for lichen planopilaris are hydroxychloroquine (Plaquenil), methotrexate, and cyclosporine. Sometimes also micophenolate mofetil, acitretin, or anti-inflammatory antibiotics such as doxycycline and minocycline. Prednisone is also effective, but due to its side effects, it is not suitable for long-term use.WHAT ARE THE OUTLOOK?Lichen planopilaris is a difficult-to-treat hair condition with a variable course. The hair loss can be stabilized or slowed with anti-inflammatory medication. It can also subside spontaneously over time. Unfortunately, it can always recur. New hair growth will not occur in the areas where scarring has occurred.WHAT CAN YOU STILL DO YOURSELF?There are no actions you can take to control the progression of lichen planopilaris. If large bald patches have developed, purchasing a wig or hairpiece is an option. Whether this is covered depends on your health insurance and the package you have. Authorization is often required, which your dermatologist can complete for you.PATIENT ASSOCIATIONThere is a patient association for people with lichen planus: www.lichenplanus.nl . You can also contact them with questions about lichen planopilaris. |
