Lichen Planopilaris Diagnosis & Scalp Treatment in London

Understanding Lichen Planopilaris

Lichen planopilaris (LPP) is a rare form of lichen planus that specifically affects the scalp and hair follicles. It causes chronic inflammation that gradually destroys follicles, replacing them with scar tissue. This leads to patchy, permanent hair loss, classifying LPP as a form of scarring alopecia.

Causes and Pathogenesis

The precise cause of LPP is not fully known, but it is believed to be autoimmune in nature. The immune system mistakenly targets hair follicle stem cells, leading to inflammation and irreversible damage. Contributing factors may include:

• Genetic predisposition
• Immune system dysregulation
• Association with other autoimmune conditions
• Hormonal and environmental triggers

Clinical Features

LPP usually presents with:

• Patches of hair loss with shiny, scarred scalp
• Redness and perifollicular scaling around affected hairs
• Sensation of burning, itching, or tenderness
• Permanent hair loss in advanced stages

Variants of LPP include frontal fibrosing alopecia (FFA), affecting the frontal hairline, and Graham-Little-Piccardi-Lasseur syndrome, involving scalp, body hair, and lichenoid papules.

Diagnosis

Diagnosis is based on clinical examination and confirmed with a scalp biopsy, which shows inflammatory cell infiltration and destruction of follicles. Dermoscopy often reveals perifollicular scaling, absence of follicular openings, and broken hairs.

Treatment Options

While there is no cure for LPP, treatment aims to halt progression, control inflammation, and preserve remaining hair. Options include:

• Topical corticosteroids: Reduce inflammation in mild cases.
• Intralesional corticosteroid injections: Targeted treatment for active patches.
• Oral steroids: For rapid control in severe disease.
• Hydroxychloroquine: Widely used first-line systemic therapy.
• Immunosuppressants: Such as methotrexate, mycophenolate mofetil, or cyclosporine for resistant cases.
• Tetracycline antibiotics: Sometimes used for their anti-inflammatory properties.

Living with Lichen Planopilaris

LPP can significantly affect confidence and mental health due to visible hair loss. Psychological support, counselling, and cosmetic solutions such as wigs or hairpieces may help. At Skinhorizon Dermatology London, we provide a holistic approach addressing both medical management and emotional wellbeing.

Your first visit — what to expect

1. Consultation: Discussion of symptoms, onset, and personal concerns.
2. Examination: Full scalp assessment, including dermoscopy.
3. Investigations: Scalp biopsy if diagnosis is uncertain.
4. Treatment planning: Individualised options to control inflammation and preserve hair.
5. Follow-up: Regular monitoring to assess response and adjust therapy.

Reviewed by: Dr Mohammad Ghazavi, Consultant Dermatologist
Skinhorizon Clinic, 4 Clarendon Terrace, Maida Vale, London W9 1BZ
Last reviewed: 21 August 2025