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Lichen Planopilaris 

Author: Iaza Hussain

Chief Editor: Dr Daniel Keith

Lichen planopilaris is an inflammatory condition that affects areas of the skin leading to permanent hair loss, and is a type of scarring alopecia. It is a variant of lichen planus. The cause is unknown but is thought to be related to inflammation, not infection. The condition results in patchy hair loss mainly on the scalp, associated with a redness and scaling of the skin around the base of the hair follicle. Other areas such as eyebrows, arm and leg hair can be affected too.

Macroscopic Appearance 

Macroscopic example in Fitzpatrick Skin Type I

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Slight redness at the hairline when compared to the skin can be observed. Additionally, there are patches of hair loss close to where the hairline used to be. 

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Dermoscopic Appearance 

Dermoscopically, findings may include:

  • Absence of follicle openings

  • Erythema

  • Irregular alopecic areas

  • Follicular plugging

  • Perifollicular whitish-grey scaling

  • Perifollicular erythema (arboriform vessels)

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The yellow arrow points to an absence of follicular openings, which can be viewed on dermoscopy as a patch of hair loss.

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Erythema is seen clearly here on dermoscopy. It is easier to see on Fitzpatrick type 1 and 2 skin.

Perifollicular scales. The spacing between the follicles is bigger and there is associated redness and flaking in the scalp.

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