Primary cicatricial alopecia - lichen planopilaris

Abstract

Introduction. Lichen planopilaris (LPP) is a follicular from of lichen planus. LPP is a rare chronic disorder of the scalp that leads to irreversible hair follicle destruction by a lymphocytic inflammation. The origin of LPP is unknown, but it is assumed that autoimmune process may cause it. LPP is a primary cicatricial alopecia and it is divided into three clinical types: classic lichen planopilaris, frontal fibrinosing alopecia and Graham-Little-Piccardi-Lassueur syndrome. Case report. A 34-year-old women had complaints of increased hair shedding and episodes of itchy rashes on the scalp. Symptoms appeared 3 years ago. Physical examination revealed 1-2 cm diameter areas of alopecia with regions of extinct follicles, follicular hyperkeratosis and erythema in temporal and occipital regions. Hair pull test and laboratory tests results were negative. Patch test with the 29 European standard allergens showed the allergy to paraphenylenediamine. Skin histopathological examination revealed normal basal membrane without mucine deposits, perifollicular lymphocytic infiltrate and vacuolar degeneration. The patient was treated with clobetasol propionate solution for 3 months, first 4 weeks under occlusion, without significant improvement, even progression of the disease was seen. The systemic therapy with hydroxychloroquine 200 mg twice daily was started. Scalp condition stabilized four months after treatment. Conclusion. Different diagnosis of classic LPP include pseudopelade Brocq, central centrifugal cicatricial alopecia and discoid lupus erythematosus. All types of LPP progresses if untreted and lead to permanent hair loss. Therefore it is very important to diagnose the disease on time and to adequately treat it.