Comprehensive Guide to LPP Hair Loss: Causes, Symptoms

Lichen Planopilaris (LPP) is a rare inflammatory skin condition that primarily targets the hair follicles of the scalp, leading to scarring and eventual hair loss in patches. Regarded as a subtype of lichen planus, LPP affects primarily adult women and people assigned female at birth who are between 40 to 60 years of age. However, it doesn't abide strictly by these demographics and can affect adults of varying ages and sexes. Despite being a leading cause of scarring alopecia, LPP is responsible for only about 1% of all hair loss cases globally.

This article aims to provide comprehensive insights into the causes, symptoms, and treatment options for LPP, including follicular lichen planus, shedding light on how this complex condition can be managed in an effective manner.

Understanding Lichen Planopilaris

Lichen Planopilaris (LPP) is an inflammatory disorder that primarily affects the scalp and hair follicles, leading to permanent scarring and hair loss However, it's not just the hair on your head that can be affected. LPP can also lead to hair loss in your eyebrows, eyelashes, and sometimes, even in your armpits and groin, making it a serious skin disease.

 

While the exact cause of LPP remains elusive, it is typically characterized by the attack on your hair follicles by T-cells, which play a critical role in your immune system. Given these factors, most experts suggest that LPP could potentially be an autoimmune disorder where healthy tissues, including hair cells, are erroneously targeted by the immune system.

Understanding Lichen Planopilaris and its potential causes is important in finding effective treatment options.

Interestingly, LPP is often associated with lichen planus—a condition that manifests as an itchy rash on your arms, legs, and inside your mouth. Nearly half of the people diagnosed with LPP also develop symptoms of lichen planus, such as ridges or splitting of the nails.

Experts emphasize that LPP is not contagious, and cannot be passed on to others. However, it's important to understand the impact it can have on your self-esteem and psychological health, given its lasting effect on physical appearance.

Causes of LPP Hair Loss

Medical professionals remain unclear about the root cause of Lpp hair loss. LPP is likely an autoimmune disease caused by T-cells, a specific type of white blood cell, attacking the body's hair follicles.

When this occurs, it triggers an inflammatory response, resulting in redness, itching, and, over time, the formation of scars in the affected areas. LPP is similar to another hair loss condition, alopecia areata, which is also caused by the immune system attacking hair follicles. However, unlike alopecia areata, Lichen planopilaris results in scarring hair loss.

Autoimmune diseases entail your immune system wrongly attacking healthy tissues in the body. In the case of LPP, the T-cells target the hair follicles, mistakenly considering them as foreign substances that need to be eradicated. This leads to the inflammation and eventual damage of the hair follicles, resulting in hair loss.

However, it's important to note that not every individual diagnosed with LPP will witness these specific immune responses. Further research is necessary to understand this complex condition fully and identify potential risk factors and causes contributing to its development.

Considering the lack of clarity on what triggers LPP, there are no known ways to prevent it. The focus remains on early detection and effective treatment to mitigate its effects and manage symptoms.

What are the Different Types of Lichen Planopilaris?

Lichen Planopilaris (LPP) presents itself in three distinct types, each manifesting differently and affecting different areas of the scalp and skin. Understanding these classifications can help healthcare providers recommend appropriate treatment protocols for patients.

Classic Lichen Planopilaris.

With this variation, scarring leads to bald patches predominantly appearing on the scalp. These patches are often accompanied by noticeable redness and a rough texture resulting from the skin's scaly condition.

Frontal Fibrosing Alopecia.

This type involves hair loss and scarring around the hairline near your forehead. In addition to scalp hair loss, this subtype can also include the loss of hair in your eyelashes or eyebrows, further complicating the condition and leading to potential aesthetic concerns.

Lassueur-Graham-Little-Piccardi Syndrome

Not only does it cause scarring and bald patches to form on your scalp, but you may also experience thinning of hair in your armpits and groin area. Additionally, you might notice inflamed, rough bumps around your hair follicles, signaling the occurrence of the inflammatory reaction at a cellular level.

While these three types collectively explain the scope of LPP, it's critical to remember that each individual's experience with this condition could be unique. The presentation, severity of symptoms, and progression rates can vary significantly, underscoring the need for personalized diagnosis and treatment plans.

Symptoms and Signs of Lichen Planopilaris

Lichen Planopilaris (LPP) manifests through a range of symptoms that can either appear suddenly or gradually over time. The symptoms primarily depend on the extent and locations affected by the disease.

What are the main symptoms of LPP hair loss?

The most common sign of LPP is the occurrence of bald patches on your scalp. These patches are typically characterized by red, inflamed skin that is thickened and appears scaly. While hair loss is frequently confined to these bald patches, you might also observe a general thinning of hair across your scalp in some cases.

Another prevalent symptom is scalp discomfort. If you are affected by LPP, you might experience scalp pain, itching, or a burning sensation. These sensations can often be severe enough to affect your daily life quality and lead to psychological distress.

It's also important to note that LPP is a form of lichen planus. As such, in nearly half of all LPP cases, individuals also develop signs of lichen planus elsewhere. This includes an itchy rash on your arms and legs and inside your mouth, as well as notable changes in your nails such as ridges or splits.

As LPP progresses, the scarring becomes more prominent, leading to permanent hair loss in the affected areas. The texture of the skin can also change, with affected regions becoming smooth and shiny due to the scarring effect. Itching and other discomfort usually persist throughout the course of the disease and can be alleviated with proper symptomatic treatment.

Diagnosis and Testing for Lichen Planopilaris

Diagnosing Lichen Planopilaris (LPP) involves a multi-step process, starting with a detailed physical examination by a dermatologist. The healthcare provider will first visually inspect the scalp and skin for signs of redness, inflammation, and hair loss characteristic of LPP. They will then make a diagnosis of lichen planopilaris through clinical examination, trichoscopy, and a scalp biopsy.

This process allows for accurate assessment of symptom severity, extent of hair loss, and disease activity, which are important factors in determining treatment. The healthcare provider may also ask about your medical history and any medications you may be taking.

To differentiate LPP from other similar skin conditions, additional diagnostic tests may be required. These can include:

• Dermoscopy: In this non-invasive diagnostic procedure, the dermatologist uses a specialized tool called a dermatoscope that allows for a close examination of your scalp and skin. They look for specific signs of LPP, such as patches of hair loss or scarring.

 

• Skin Biopsy: To confirm the diagnosis, a small sample of skin from the affected area might be taken for pathological investigation. In the laboratory, the biopsy specimen is microscopically evaluated for tell-tale signs of LPP, including inflammation around the hair follicles, and reduced or absent hair follicles.

Diagnosing LPP as early as possible is crucial to control the disease's progression and prevent extensive hair loss. Once diagnosed, the healthcare provider can help formulate an appropriate treatment plan to manage symptoms and slow down the rate of hair loss.

Treatment Options for Lichen Planopilaris

Medical treatments are primarily aimed at controlling inflammation and involve the use of drugs, such as topical and oral corticosteroids, as well as retinoids, administered topically, orally or by injection.

For some patients, laser therapy can offer relief from symptoms. Maintaining regular check-ups with a dermatologist is crucial to monitoring the disease's progression and adjusting treatment plans as needed.

Drug Treatments for Lichen Planopilaris

There's a range of medication options available to manage the symptoms of Lpp hair loss and slow its onset.

• Corticosteroids: These anti-inflammatory drugs help reduce the immune response and associated inflammation. They can be applied directly to the scalp (topical corticosteroids), taken orally, or injected into the lesions (intralesional corticosteroids).
• Retinoids: These Vitamin A derivatives can help slow down overactive cell growth and reduce inflammation. Retinoids are available in oral forms (such as isotretinoin) or topical creams or gels (like tretinoin).
• Anti-malarial drugs: Medications like hydroxychloroquine, initially designed to treat malaria, can also help manage some inflammatory skin conditions, including LPP.
• Antibiotics: Particularly ones with anti-inflammatory properties, like doxycycline or tetracycline, can be used to control the symptoms of LPP.
• Immunosuppressant drugs: Drugs like methotrexate or ciclosporin may also be used to suppress the body's immune response and provide symptom relief.
• JAK inhibitors: Oral medication such as tofacitinib can significantly reduce itching and halt disease progression.

The recommended drug treatment would depend heavily upon individual symptoms and the severity of the condition.

Non Drug Treatments and Home Care

In addition to medical interventions, several nonsurgical and home care treatments can manage Lpp hair loss symptoms or prevent them from getting worse.

• Special Hair Care: Avoiding hair styling techniques that pull or stress the hair could alleviate symptoms. Restricting hair straighteners, blow dryers, and other high-heat hair styling tools is recommended.
• Gentle Shampooing: Regular gentle shampooing can help keep the scalp clean and reduce irritation and scaling. Shampoos containing corticosteroids could also be advantageous.
• Wearing Sunscreen: Wearing a hat or sunscreen can reduce possible sun aggravation that may intensify the symptoms.
• Protect Scalp: Covering your head with scarves, hats, or wigs can help protect your skin from cold air and sunlight. It can also help conceal hair loss.

Below is a table summarizing commonly recommended non-drug treatments for Lpp hair loss:

Treatment	Description
Special Hair Care	Avoid pulling/stretching hair and high heat styling tools
Gentle Shampooing	Regular shampooing to keep scalp clean
Wearing Sunscreen	Sun Protection to prevent aggravating symptoms
Protect Scalp	Use of scarves, hats or wigs to cover the head and protect the scalp

How can I prevent Lichen Planopilaris?

Unfortunately, there is no known way to prevent Lpp hair loss as the exact cause remains unknown. Moreover, since LPP is likely an autoimmune disorder, it implies that it arises from complex interactions between various genetic and environmental factors, most of which are beyond our direct control.

While specific preventive measures may not exist currently, it's crucial to avoid ignoring any changes in the skin or hair loss. If you notice any early signs of LPP like patches of hair loss or a recurrent itchy rash, seeking immediate medical attention is advisable. Initiation of treatment in the early stages could potentially prevent further hair loss and manage the symptoms efficiently, making it the best first step in managing Lichen Planopilaris.

Furthermore, for people diagnosed with Lichen Planopilaris, it's essential to follow all treatment protocols diligently to prevent the progression of the disease and to control the symptoms.

While it may not be possible to completely prevent LPP, being aware of potential risk factors and seeking early medical assistance can greatly improve outcomes.

Conclusion

Lichen Planopilaris, although challenging, is manageable with the appropriate treatment and care. The complexity of this condition necessitates the importance of knowledge and understanding of its types, causes, symptoms, diagnostic methods, and available treatments. While there are still many unknowns about LPP, great strides have been made in diagnosing and treating this condition that once meant a certain and unstoppable journey toward permanent hair loss.

It's important to note that the real determining factor lies in the early identification of the condition and commencement of treatment. Reach out to a healthcare professional if you observe persistent symptoms like unexplained hair loss, scalp pain, itching, or red patches on the scalp. While there is currently no cure, medications and care strategies can help make a living with LPP more manageable, slow the progression of hair loss, and even improve the quality of life for those affected by this condition.

Frequently Asked Questions

Is Lichen Planopilaris contagious?

No, Lichen Planopilaris (LPP) is not a contagious condition. It is an autoimmune disorder where the immune system erroneously targets the body's own tissues—in the case of LPP, the hair follicles. Consequently, it cannot be transferred from person to person.

What is the difference between Lichen Planopilaris and other hair loss conditions?

The key difference between Lichen Planopilaris (LPP) and most other hair loss conditions is that LPP leads to scarring in the affected areas. This scarring permanently destroys the hair follicles, causing irreversible hair loss, unlike many other types of hair loss, which may be temporary.

Will hair grow back after successful treatment of LPP?

Unfortunately, hair loss due to Lichen Planopilaris (LPP) does not regrow even after successful treatment. This is because the scarring caused by LPP permanently damages the hair follicles. However, successful treatment can prevent additional hair loss and control symptoms, offering some relief.

When should I consult a dermatologist for LPP-related symptoms?

If you notice unexplained hair loss, particularly in patches, or persistent itchiness and redness on your scalp, it is advisable to seek immediate medical advice. Early detection and treatment can slow down the progression of Lichen Planopilaris and provide relief from symptoms.

Is Lichen Planopilaris the Same as Alopecia Areata?

Lichen Planopilaris and Alopecia Areata are both conditions that affect the hair and scalp, but they are not the same. Lichen Planopilaris is a rare inflammatory condition that can result in permanent hair loss, scarring, and damage to the hair follicles. On the other hand, Alopecia Areata is an autoimmune disorder that causes patchy hair loss on the scalp or body, but it does not usually cause scarring or permanent baldness.