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Lichen planopilaris

Authors
Jerry Shapiro, MD
Nina Otberg, MD
Section Editor
Maria Hordinsky, MD
Deputy Editor
Abena O Ofori, MD

INTRODUCTION

Lichen planopilaris (LPP) is an uncommon inflammatory scalp disorder that is clinically characterized by perifollicular erythema, follicular hyperkeratosis, and permanent hair loss. LPP is considered a follicular form of lichen planus based upon shared pathologic features and the frequent coexistence of clinical findings of these disorders. (See "Lichen planus".)

LPP is divided into three clinical variants:

Classic LPP

Frontal fibrosing alopecia (FFA)

Graham-Little-Piccardi-Lasseur syndrome (Graham-Little syndrome, GLPLS)

                                    

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Literature review current through: Aug 2016. | This topic last updated: Sep 30, 2015.
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References
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  1. Olsen E, Stenn K, Bergfeld W, et al. Update on cicatricial alopecia. J Investig Dermatol Symp Proc 2003; 8:18.
  2. Tan E, Martinka M, Ball N, Shapiro J. Primary cicatricial alopecias: clinicopathology of 112 cases. J Am Acad Dermatol 2004; 50:25.
  3. Ochoa BE, King LE Jr, Price VH. Lichen planopilaris: Annual incidence in four hair referral centers in the United States. J Am Acad Dermatol 2008; 58:352.
  4. Chieregato C, Zini A, Barba A, et al. Lichen planopilaris: report of 30 cases and review of the literature. Int J Dermatol 2003; 42:342.
  5. Handa S, Sahoo B. Childhood lichen planus: a study of 87 cases. Int J Dermatol 2002; 41:423.
  6. Mehregan DA, Van Hale HM, Muller SA. Lichen planopilaris: clinical and pathologic study of forty-five patients. J Am Acad Dermatol 1992; 27:935.
  7. Vañó-Galván S, Molina-Ruiz AM, Serrano-Falcón C, et al. Frontal fibrosing alopecia: a multicenter review of 355 patients. J Am Acad Dermatol 2014; 70:670.
  8. MacDonald A, Clark C, Holmes S. Frontal fibrosing alopecia: a review of 60 cases. J Am Acad Dermatol 2012; 67:955.
  9. Tan KT, Messenger AG. Frontal fibrosing alopecia: clinical presentations and prognosis. Br J Dermatol 2009; 160:75.
  10. Samrao A, Chew AL, Price V. Frontal fibrosing alopecia: a clinical review of 36 patients. Br J Dermatol 2010; 163:1296.
  11. László FG. Graham-Little-Piccardi-Lasseur syndrome: case report and review of the syndrome in men. Int J Dermatol 2014; 53:1019.
  12. Atanaskova Mesinkovska N, Brankov N, Piliang M, et al. Association of lichen planopilaris with thyroid disease: a retrospective case-control study. J Am Acad Dermatol 2014; 70:889.
  13. Mobini N, Tam S, Kamino H. Possible role of the bulge region in the pathogenesis of inflammatory scarring alopecia: lichen planopilaris as the prototype. J Cutan Pathol 2005; 32:675.
  14. Assouly P, Reygagne P. Lichen planopilaris: update on diagnosis and treatment. Semin Cutan Med Surg 2009; 28:3.
  15. Karnik P, Tekeste Z, McCormick TS, et al. Hair follicle stem cell-specific PPARgamma deletion causes scarring alopecia. J Invest Dermatol 2009; 129:1243.
  16. Rodríguez-Bayona B, Ruchaud S, Rodríguez C, et al. Autoantibodies against the chromosomal passenger protein INCENP found in a patient with Graham Little-Piccardi-Lassueur syndrome. J Autoimmune Dis 2007; 4:1.
  17. Tosti A, Piraccini BM, Iorizzo M, Misciali C. Frontal fibrosing alopecia in postmenopausal women. J Am Acad Dermatol 2005; 52:55.
  18. Ross EK, Tan E, Shapiro J. Update on primary cicatricial alopecias. J Am Acad Dermatol 2005; 53:1.
  19. Wiedemeyer K, Schill WB, Löser C. Diseases on hair follicles leading to hair loss part II: scarring alopecias. Skinmed 2004; 3:266.
  20. ALTMAN J, PERRY HO. The variations and course of lichen planus. Arch Dermatol 1961; 84:179.
  21. Matta M, Kibbi AG, Khattar J, et al. Lichen planopilaris: a clinicopathologic study. J Am Acad Dermatol 1990; 22:594.
  22. Giménez-García R, Lázaro-Cantalejo TE, Sánchez-Ramón S, Velasco Fernandez C. Linear lichen planopilaris of the face. J Eur Acad Dermatol Venereol 2005; 19:770.
  23. Baker K, Pehr K. Linear lichen planopilaris of the trunk: first report of a case. J Cutan Med Surg 2006; 10:136.
  24. Kossard S, Lee MS, Wilkinson B. Postmenopausal frontal fibrosing alopecia: a frontal variant of lichen planopilaris. J Am Acad Dermatol 1997; 36:59.
  25. Tosti A, Miteva M, Torres F. Lonely hair: a clue to the diagnosis of frontal fibrosing alopecia. Arch Dermatol 2011; 147:1240.
  26. Donati A, Molina L, Doche I, et al. Facial papules in frontal fibrosing alopecia: evidence of vellus follicle involvement. Arch Dermatol 2011; 147:1424.
  27. Lopez-Pestana A, Tuneu A, Lobo C. Facial lesions in frontal fibrosing alopecia (FFA): Clinicopathological features in a series of 12 cases. J Am Acad Dermatol 2015.
  28. Bianchi L, Paro Vidolin A, Piemonte P, et al. Graham Little-Piccardi-Lassueur syndrome: effective treatment with cyclosporin A. Clin Exp Dermatol 2001; 26:518.
  29. Mirmirani P, Willey A, Price VH. Short course of oral cyclosporine in lichen planopilaris. J Am Acad Dermatol 2003; 49:667.
  30. Duque-Estrada B, Tamler C, Sodré CT, et al. Dermoscopy patterns of cicatricial alopecia resulting from discoid lupus erythematosus and lichen planopilaris. An Bras Dermatol 2010; 85:179.
  31. Miteva M, Tosti A. Dermoscopy guided scalp biopsy in cicatricial alopecia. J Eur Acad Dermatol Venereol 2013; 27:1299.
  32. Weedon D. The lichenoid reaction pattern (interface dermatitis). In: Weedon's Skin Pathology, 3rd ed, Elsevier Limited, Edinburgh 2010. p.35.
  33. Mobini N, Toussaint S, Kamino H. Noninfectious erythematous, papular, and squamous diseases. In: Lever's Histopathology of the Skin, 10th ed, Elder DE (Ed), Lippincott Williams & Wilkins, Philadelphia 2009. p.169.
  34. Weedon D. Diseases of cutaneous appendages. In: Weedon's Skin Pathology, 3rd ed, Elsevier Limited, Edinburgh 2010. p.397.
  35. Ioffreda MD. Inflammatory diseases of hair follicles, sweat glands, and cartilage. In: Lever's Histopathology of the Skin, 10th ed, Elder DE (Ed), Lippincott Williams & Wilkins, Philadelphia 2009. p.459.
  36. Dlova NC, Jordaan HF, Skenjane A, et al. Frontal fibrosing alopecia: a clinical review of 20 black patients from South Africa. Br J Dermatol 2013; 169:939.
  37. Rácz E, Gho C, Moorman PW, et al. Treatment of frontal fibrosing alopecia and lichen planopilaris: a systematic review. J Eur Acad Dermatol Venereol 2013; 27:1461.
  38. Cevasco NC, Bergfeld WF, Remzi BK, de Knott HR. A case-series of 29 patients with lichen planopilaris: the Cleveland Clinic Foundation experience on evaluation, diagnosis, and treatment. J Am Acad Dermatol 2007; 57:47.
  39. Newton RC, Hebert AA, Freese TW, Solomon AR. Scarring alopecia. Dermatol Clin 1987; 5:603.
  40. Wiseman MC, Shapiro J. Scarring alopecia. J Cutan Med Surg 1999; 3 Suppl 3:S45.
  41. Chiang C, Sah D, Cho BK, et al. Hydroxychloroquine and lichen planopilaris: efficacy and introduction of Lichen Planopilaris Activity Index scoring system. J Am Acad Dermatol 2010; 62:387.
  42. Spencer LA, Hawryluk EB, English JC 3rd. Lichen planopilaris: retrospective study and stepwise therapeutic approach. Arch Dermatol 2009; 145:333.
  43. Cho BK, Sah D, Chwalek J, et al. Efficacy and safety of mycophenolate mofetil for lichen planopilaris. J Am Acad Dermatol 2010; 62:393.
  44. Baibergenova A, Walsh S. Use of pioglitazone in patients with lichen planopilaris. J Cutan Med Surg 2012; 16:97.
  45. Mirmirani P, Karnik P. Lichen planopilaris treated with a peroxisome proliferator-activated receptor gamma agonist. Arch Dermatol 2009; 145:1363.
  46. Mesinkovska NA, Tellez A, Dawes D, et al. The use of oral pioglitazone in the treatment of lichen planopilaris. J Am Acad Dermatol 2015; 72:355.
  47. Spring P, Spanou Z, de Viragh PA. Lichen planopilaris treated by the peroxisome proliferator activated receptor-γ agonist pioglitazone: lack of lasting improvement or cure in the majority of patients. J Am Acad Dermatol 2013; 69:830.
  48. Navarini AA, Kolios AG, Prinz-Vavricka BM, et al. Low-dose excimer 308-nm laser for treatment of lichen planopilaris. Arch Dermatol 2011; 147:1325.
  49. Ott F, Bollag W, Geiger JM. Efficacy of oral low-dose tretinoin (all-trans-retinoic acid) in lichen planus. Dermatology 1996; 192:334.
  50. Moreno-Ramírez D, Camacho Martínez F. Frontal fibrosing alopecia: a survey in 16 patients. J Eur Acad Dermatol Venereol 2005; 19:700.
  51. Georgala S, Katoulis AC, Befon A, et al. Treatment of postmenopausal frontal fibrosing alopecia with oral dutasteride. J Am Acad Dermatol 2009; 61:157.
  52. Ladizinski B, Bazakas A, Selim MA, Olsen EA. Frontal fibrosing alopecia: a retrospective review of 19 patients seen at Duke University. J Am Acad Dermatol 2013; 68:749.
  53. Vashi N, Newlove T, Chu J, et al. Graham-Little-Piccardi-Lassueur syndrome. Dermatol Online J 2011; 17:30.
  54. Donovan J. Lichen planopilaris after hair transplantation: report of 17 cases. Dermatol Surg 2012; 38:1998.
  55. Chiang YZ, Tosti A, Chaudhry IH, et al. Lichen planopilaris following hair transplantation and face-lift surgery. Br J Dermatol 2012; 166:666.
  56. Crisóstomo MR, Crisóstomo MC, Crisóstomo MG, et al. Hair loss due to lichen planopilaris after hair transplantation: a report of two cases and a literature review. An Bras Dermatol 2011; 86:359.
  57. Jiménez F, Poblet E. Is hair transplantation indicated in frontal fibrosing alopecia? The results of test grafting in three patients. Dermatol Surg 2013; 39:1115.
  58. Nusbaum BP, Nusbaum AG. Frontal fibrosing alopecia in a man: results of follicular unit test grafting. Dermatol Surg 2010; 36:959.