Lichen Follicular lichen plants (LPP) is an uncommon variant of lichen plants that predominantly impacts the scalp and hair follicles, resulting in scarring alopecia, which is distinguished by irreversible hair loss. This inflammatory condition impedes the normal functioning of hair follicles, leading to hair thinning, patchy baldness, and ultimately scarring. Lichen Follicular lichen plants is classified as an autoimmune disorder, wherein the immune system erroneously attacks the body’s own tissues, specifically targeting the hair follicles.
Lichen Follicular lichen plants Overview
Definition: Lichen Follicular lichen plants is a specific manifestation of lichen plants, a state that usually affects the skin and mucous membranes; however, in the case of LPP, it specifically necessitate the hair follicles on the scalp and, less frequently, other areas of the body with hair.
Prevalence: LPP is considered rare, and its precise prevalence remains uncertain. It is more frequently observed in adults, with a higher incidence in women compared to men. The circumstances can manifest at any age, but it is most prevalent among middle-aged individuals.
Symptoms and Signs of Lichen Follicular lichen plants
The manifestations of Lichen Follicular lichen plants are primarily localised to the scalp, although it may also impact other areas with hair, such as the eyebrows, eyelashes, and body hair.
Hair Loss:
– The onset of hair loss typically presents as small, round patches of thinning or baldness, which may gradually enlarge over time.
– Scarring alopecia: In contrast to other types of hair loss, LPP inflicts permanent damage to the hair follicles, resulting in irreversible hair loss in the affected regions.
Itching and Tenderness:
– The scalp may experience sensations of itchiness, tenderness, or a burning feeling, particularly in areas where hair loss is evident.
Smarting
– The skin surrounding the pretentious hair follicles may exhibit redness, inflammation, or irritation.
Scaling and Crusting:
– The impacted areas may develop fine scaling or crusting on the skin, often surrounding the hair follicles.
Follicular Hyperkeratosis:
The presence of small elevations or follicular plugs around hair follicles is indicative of keratin accumulation.
White, Shiny Scarring:
As the condition advances, scarring may result in a smooth, glossy, and often lighter appearance of the scalp, attributed to the loss of hair follicles replaced by scar tissue.
Eyebrows/Eyelashes:
Though uncommon, Lichen Planopilaris (LPP) can also impact the eyebrows, eyelashes, or body hair, resulting in thinning or loss in these regions.
Causes of Lichen Planopilaris
The exact aetiology of LPP remains unclear; however, it is thought to be an autoimmune disorder wherein the immune system erroneously targets hair follicles as foreign entities. Several factors may influence the development of LPP:
Autoimmune Response: The immune system attacks and damages hair follicles, causing inflammation and subsequent scarring.
Genetic Factors: A hereditary component may exist, as LPP can sometimes be observed within families.
Factor Hormonalrs: There is some evidence indicating that hormonal influences may be significant, as LPP is more prevalent in women.
Environmental Triggers: Certain environmental conditions or infections might initiate or worsen LPP, although this remains inadequately defined.
Previous Skin Conditions: Individuals with other forms of lichen planus or conditions such as hepatitis C may experience Lichen Planopilaris.
Diagnosis of Lichen Planopilaris
To diagnose LPP, a dermatologist will generally evaluate the patient’s clinical symptoms and may perform the following:
Physical Examination:
A thorough examination of the scalp to identify characteristic signs, including hair loss, redness, scaling, and follicular irregularities.
Skin Biopsy:
A biopsy may be conducted to obtain a small skin sample from an affected area for microscopic analysis. Histopathological findings typically reveal:
Lymphocytic Infiltrate: An aggregation of white blood cells (lymphocytes) surrounding hair follicles.
Cavate Bodies: Degenerating keratinocytes (skin cells) present in the affected skin.
Management of Lichen Planopilaris
While a definitive cure for Lichen Planopilaris (LPP) does not exist, various treatment options can assist in managing the condition, alleviating inflammation, and minimising additional hair loss. The primary objective of treatment is to alleviate symptoms and hinder the advancement of the disease.
Topical Corticosteroids:
Potent topical steroids are frequently employed to diminish inflammation and slow the deterioration of hair follicles.
Oral Medications:
Oral corticosteroids: In cases that are more extensive or severe, oral steroids may be utilised to inhibit the immune response.
Hydroxychloroquine: This antimalarial drug can be beneficial for autoimmune skin conditions, including LPP.
Immunosuppressive Agents: Medications such as methotrexate or cyclosporine may be prescribed for cases that are more resistant to standard treatments to suppress the immune system.
Topical Calcineurin Inhibitors:
Agents like tacrolimus or pimecrolimus can effectively manage inflammation without the adverse effects associated with steroids.
Phototherapy (UVB Light Therapy):
Ultraviolet light therapy may be employed to help alleviate inflammation and regulate the autoimmune response in certain patients.
Minoxidil:
Although it is not a cure, minoxidil (often used for hair regrowth in conditions such as androgenetic alopecia) may promote hair growth in some individuals with LPP.
Platelet-Rich Plasma (PRP) Therapy:
Some patients have reported positive outcomes with PRP therapy, which involves processing the patient’s blood to concentrate platelets and subsequently injecting them into the scalp to encourage hair growth.
Lifestyle Adjustments:
Minimising scalp irritation, steering clear of harsh hair treatments, and effectively managing stress can contribute to symptom management.
Prognosis and Outlook
The prognosis for LPP can differ significantly. Some individuals may experience intermittent periods of remission, while others may face ongoing hair loss. Key factors that influence the outcome include:
Timely Diagnosis and Treatment: Early intervention can help prevent further scarring and irreversible hair loss.
Severity: Individuals with more extensive involvement or those who do not respond to treatment may encounter more pronounced permanent hair loss.
Psychosocial Impact
Lichen planopilaris, particularly when it results in irreversible hair loss, can exert a profound emotional and psychological toll on affected individuals. Many people suffering from LPP may encounter feelings of anxiety, depression, or diminished self-esteem stemming from noticeable alterations in their appearance. Participation in support groups and seeking counselling can assist those impacted in coping with the emotional difficulties associated with this condition.
Conclusion
Lichen planopilaris is a chronic and frequently progressive disorder that leads to permanent hair loss due to scarring. Although a definitive cure is not available, prompt diagnosis. A customised treatment strategy can aid in managing the condition and mitigating further damage. It is essential for individuals with LPP to collaborate closely with a dermatologist to address their symptoms and investigate the most effective treatment alternatives for their specific situation.
