Information and Solutions for Men and Women

Lichen Planus Cicatricial Alopecias

Lichen planus can cause permanent hair loss, especially in women after menopause.

Lichen planus is an inflammatory disease that can cause permanent, scarring hair loss. Recent studies indicate that there may also be a genetic hereditary component in some types of lichen planus cicatricial alopecias. In addition, in a case involving one type researchers identified a protein auto-antigen that the immune system targets—suggesting that these may be autoimmune disorders as well.186

As a group, the vast majority of lichen planus alopecia cases occur between the ages of 30 and 70 years old. Scalp lesions in lichen planus initially appear as purple-colored bumps, reddened skin, and scaling, which are soon replaced by plugged follicles and scarring. These plugged follicles are similar to keratosis pilaris, a common condition where keratin proteins in the skin accumulate and harden into plugs in the hair follicle orifices.22, 187

The follicular plugs shed from the inside of the lesions outward, leaving smooth, atrophied skin. Lesions can be similar to other scaling scalp conditions, but the presence of visible nail shedding and microscopic detection of specific damage to basal skin cells distinguish the lichen planus conditions from others.22

There are three types of lichen planus cicatricial alopecias:2, 13, 22, 76

Table 37: Types of Lichen Planus Cicatricial Alopecias

TYPES OF LICHEN PLANUS CICATRICIAL HAIR LOSS

TYPE

CHARACTERISTICS

FRONTAL FIBROSING
ALOPECIA
  • Occurs almost exclusively in postmenopausal women.
  • Involves scarring frontal hairline loss (in a straight line, not bitemporally as in female pattern hair loss).
  • Non-scarring eyebrow loss.
  • Slowly progressing hair loss over many years thought to be caused by multiple types of immune cells targeting the hair follicles.
GRAHAM-LITTLE SYNDROME
  • Almost all cases occur in postmenopausal women.
  • Involves lesions and scarring hair loss on the crown similar to lichen planopilaris cases, followed by areas of keratosis pilaris-like spiny protrusions from the follicles on the scalp, eyebrows, and other body areas.
LICHEN PLANOPILARIS
  • Mostly occurs in middle-aged and elderly women.
  • Typically hair loss and lesions appear in scalp crown area.
  • Believed to be caused by white blood cells attacking the hair follicles.
LICHEN PLANOPILARIS
  • Mostly occurs in middle-aged and elderly women.
  • Typically hair loss and lesions appear in scalp crown area.
  • Believed to be caused by white blood cells attacking the hair follicles

Treatments for Lichen Planopilaris

Lichen planopilaris, like other cicatricial alopecias, is difficult to treat in terms of hair regrowth or stabilizing the disease. However, there are some options which have shown limited success in treating lichen planus or alleviating the itch and pain associated the condition:22

  • Cyclosporine (oral, 250-400 mg/day for 4-8 months)188
  • Dutasteride (oral) and topical pimecrolimus 1%189
  • Steroid injections into active inflammatory lesions22
  • Systemic corticosteroids22
  • Tetracycline190
  • Thalidomide (only after all other treatments are exhausted and strict adherence to contraceptive use by both male and female patients because of risk for serious birth defects)191
  • Topical retinoids (e.g., acitretin)22
  • Topical steroids twice a day mostly for symptom relief (e.g., clobetasol propionate ointment)22

In addition, surgical hair transplants have proven to be successful in some patients with dormant disease, by itself and combined with topical minoxidil.24, 192

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