Follicular lichen planus (FLP) is a rare and severe form of lichen planus, a chronic autoimmune skin disorder that affects the hair follicles and causes itching, scaling, and hair loss. FLP is characterized by the formation of small, circular, or oval-shaped, reddish-purple papules or plaques on the scalp, neck, and face, which may progress to form thick, scaly patches with central hair loss. The hair follicles are usually involved in FLP, and the hair shafts may become thickened and twisted, leading to scarring alopecia and permanent hair loss.
Here are some of the key definitions related to FLP:
- Lichen planus: A common autoimmune skin condition that causes itchy, scaly patches on the skin, scalp, mouth, and genital areas.
- Chronic: A long-lasting or persistent condition that does not go away easily.
- Autoimmune: A condition in which the immune system mistakenly attacks and damages the body’s own tissues.
- Hair follicles: Tiny sacs in the skin that contain the root of a hair and produce new hair growth.
- Itching: A sensation that causes an urge to scratch the skin.
- Scaling: A condition in which the skin forms thick, flaky patches that can be easily removed.
- Hair loss: A condition in which hair is lost from the scalp or other parts of the body.
- Papules: Small, raised, solid bumps on the skin that are less than 0.5 cm in size.
- Plaques: Large, flat areas of skin that are raised and have a rough, scaly surface.
- Scarring alopecia: A type of hair loss that occurs when hair follicles are destroyed, resulting in permanent hair loss.
- Alopecia: A general term used to describe hair loss from any part of the body.
- Scalp: The skin covering the top of the head.
- Neck: The area of skin surrounding the neck and extending to the shoulders.
- Face: The front part of the head that includes the eyes, nose, mouth, and cheeks.
- Reddish-purple: A color that is a combination of red and purple.
- Papules or plaques: Small, raised, solid bumps on the skin that are less than 0.5 cm in size or large, flat areas of skin that are raised and have a rough, scaly surface.
- Thick, scaly patches: Areas of skin that are raised and have a rough, scaly surface.
- Central hair loss: Hair loss that occurs in the center of the scalp or other affected area.
- Hair shafts: The part of the hair that extends from the root to the tip and is visible above the skin.
- Twisted: A condition in which the hair shaft becomes distorted and deformed.
FLP is a rare form of lichen planus that affects the hair follicles, causing itching, scaling, and hair loss. The hair follicles may become involved, leading to scarring alopecia and permanent hair loss. The condition is characterized by the formation of small, circular, or oval-shaped, reddish-purple papules or plaques on the scalp, neck, and face, which may progress to form thick, scaly patches with central hair loss. Understanding the key definitions related to FLP is important in order to accurately diagnose and treat the condition
Causes
Follicular lichen planus is a chronic autoimmune skin condition that causes itching and scaling of the skin, hair loss, and follicular papules. The exact causes of follicular lichen planus are still not fully understood, but several factors have been linked to the development of the condition. In this article, we will discuss the main causes of follicular lichen planus in detail.
- Genetic factors
Follicular lichen planus is believed to have a genetic component, meaning that the condition may be inherited from a person’s parents. However, the specific genes that may be involved in the development of follicular lichen planus have not yet been identified.
- Immunological factors
Follicular lichen planus is considered an autoimmune condition, which means that the immune system attacks the body’s own cells and tissues. In the case of follicular lichen planus, the immune system attacks the hair follicles, leading to hair loss and the formation of follicular papules. The exact mechanisms behind this immune attack are not fully understood, but it is believed that certain cytokines and other immune-related factors may play a role.
- Environmental factors
There are several environmental factors that have been linked to the development of follicular lichen planus, including exposure to certain chemicals, such as hair dyes and hair-care products. In some cases, exposure to certain medications, such as beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and antimalarials, has also been linked to the development of follicular lichen planus.
- Infections
There is some evidence to suggest that infections, such as hepatitis C, may play a role in the development of follicular lichen planus. In particular, the hepatitis C virus has been linked to the development of lichen planus in the oral cavity, and it is believed that the virus may trigger an immune response that leads to the development of the condition.
- Stress
Stress has also been linked to the development of follicular lichen planus. Stress can affect the immune system, leading to a heightened immune response and increased inflammation in the body. This increased inflammation may trigger an immune attack on the hair follicles, leading to hair loss and the formation of follicular papules.
- Hormonal factors
Hormonal changes, such as those that occur during pregnancy or menopause, have also been linked to the development of follicular lichen planus. In particular, changes in the levels of estrogen and progesterone have been linked to the development of the condition.
- Nutritional factors
There is some evidence to suggest that deficiencies in certain nutrients, such as vitamins B12 and C, may play a role in the development of follicular lichen planus. Additionally, a diet high in processed foods and low in fresh fruits and vegetables has been linked to an increased risk of developing autoimmune conditions, including follicular lichen planus.
Symptoms
The following is a list of symptoms associated with FLP:
- Scalp lesions: The most common symptom of FLP is the presence of scaly, red, and itchy lesions on the scalp. These lesions may be painful and can cause significant discomfort. They can also lead to hair loss, which can be permanent in some cases.
- Alopecia: FLP can cause alopecia, or hair loss, in the affected areas. This can result in patches of baldness or thinning hair.
- Scalp itching: FLP can cause intense itching of the scalp, which can be extremely uncomfortable and difficult to manage.
- Scalp pain: The lesions associated with FLP can be painful, especially when touched or combed. This can make it difficult to sleep or perform daily activities.
- Nail changes: In some cases, FLP can cause changes in the nails, such as thickening, ridging, or splitting.
- Skin discoloration: FLP can cause skin discoloration in the affected areas, which can be noticeable and unsightly.
- Scarring: FLP can cause scarring in the affected areas, which can be permanent and disfiguring.
- Systemic symptoms: In rare cases, FLP can cause systemic symptoms, such as joint pain, fatigue, and weight loss.
- Worsening of symptoms: FLP can worsen over time, causing more hair loss, itching, and pain. This can be distressing for those affected by the condition.
- Psychological impact: FLP can have a significant psychological impact on those affected, causing feelings of insecurity, embarrassment, and low self-esteem.
Diagnosis
In order to diagnose follicular lichen planus, a variety of diagnostic tests are performed. These tests help to confirm the presence of the disease and to determine the extent of its severity.
- Physical examination
A physical examination is the first diagnostic test performed for follicular lichen planus. During this test, the doctor will examine the affected area of the skin to assess the size, shape, and color of the bumps. The doctor may also ask questions about the patient’s symptoms, such as itching or burning sensations, and the duration of the symptoms.
- Skin biopsy
A skin biopsy is a diagnostic test in which a small piece of skin is removed and examined under a microscope. This test is performed to determine the presence of follicular lichen planus and to exclude other possible causes of the symptoms. A skin biopsy is usually performed by numbing the affected area with a local anesthetic and then removing a small piece of skin with a sharp instrument.
- Direct immunofluorescence
Direct immunofluorescence is a diagnostic test that helps to determine the presence of antibodies in the skin. This test is performed by applying a small amount of a fluorescent dye to the affected area of the skin and then examining it under a microscope. The presence of antibodies in the skin is an indicator of follicular lichen planus.
- Patch test
A patch test is a diagnostic test that helps to determine the presence of an allergy. During this test, small amounts of various substances are placed on the skin and then covered with a patch. The patch is left in place for 24 to 48 hours and then removed. The presence of a rash or other reaction on the skin is an indicator of an allergy.
- Blood tests
Blood tests are performed to determine the presence of any underlying conditions that may be contributing to the symptoms of follicular lichen planus. These tests may include a complete blood count, a liver function test, and a kidney function test.
- Scraping test
A scraping test is a diagnostic test that helps to determine the presence of a fungal infection. During this test, a small amount of skin is scraped from the affected area and then examined under a microscope. The presence of a fungal infection is an indicator of follicular lichen planus.
- Culture test
A culture test is a diagnostic test that helps to determine the presence of a bacterial infection. During this test, a small amount of skin is removed from the affected area and then placed in a culture medium. The culture is then examined under a microscope to determine the presence of bacteria.
- Wood’s lamp test
A Wood’s lamp test is a diagnostic test that helps to determine the presence of a fungal infection. During this test, a special type of ultraviolet light is shone on the affected area of the skin. The presence of a fungal infection is indicated by a change in the color of the skin.
- Photo testing
Phototesting is a diagnostic test that helps to determine the presence of an allergy to sunlight. During this test, the affected area of the skin is exposed to various types of light, including ultraviolet light. The presence of an allergy to sunlight is indicated by a rash or other reaction on the skin.
- Histology
Histology is a diagnostic test that helps to determine the presence of follicular lichen planus
Treatment
There is no cure for follicular lichen planus, but several treatments are available to manage the symptoms.
Here is a list of the main treatments for follicular lichen planus:
- Topical corticosteroids: Topical corticosteroids are the most commonly used treatment for follicular lichen planus. They help to reduce inflammation and itching. Topical corticosteroids can be applied directly to the affected skin.
- Oral corticosteroids: In severe cases of follicular lichen planus, oral corticosteroids may be prescribed. Oral corticosteroids are more effective than topical corticosteroids in reducing inflammation and itching. However, they also have more side effects, such as weight gain, mood swings, and an increased risk of infections.
- Antihistamines: Antihistamines are medications that help to reduce itching and swelling. They are often prescribed to relieve the symptoms of follicular lichen planus. Antihistamines can be taken orally or applied topically.
- Topical calcineurin inhibitors: Topical calcineurin inhibitors are medications that help to suppress the immune system. They are often used to treat skin conditions, such as psoriasis and eczema. Topical calcineurin inhibitors are applied directly to the affected skin.
- Phototherapy: Phototherapy is a treatment that uses light to treat skin conditions. It is often used to treat follicular lichen planus. Phototherapy can be done at a dermatologist’s office or at home using a special light device.
- Systemic immunosuppressive medications: Systemic immunosuppressive medications are medications that suppress the immune system. They are often used to treat autoimmune conditions, such as rheumatoid arthritis and lupus. Systemic immunosuppressive medications are taken orally.
- Topical retinoids: Topical retinoids are medications that are derived from Vitamin A. They are often used to treat acne and other skin conditions. Topical retinoids can be applied directly to the affected skin.
- Laser therapy: Laser therapy is a treatment that uses light to destroy the affected skin cells. It is often used to treat skin conditions, such as acne and wrinkles. Laser therapy can be done at a dermatologist’s office.
- Hair transplantation: Hair transplantation is a surgical procedure that involves transplanting hair from one area of the scalp to another. It is often used to treat hair loss caused by follicular lichen planus. Hair transplantation can be done at a dermatologist’s office.
- Supportive care: Supportive care is a type of treatment that is designed to help manage the symptoms of follicular lichen planus. This may include using medicated shampoos, avoiding triggers that may worsen the condition, and using over-the-counter creams and ointments to relieve itching and inflammation.
It is important to note that the best treatment for follicular lichen planus will depend on the severity of the condition, the individual’s overall health, and their personal preferences. A dermatologist can help to determine the best treatment plan for each individual case.
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