Lichen planus follicularis (LPF) is a subtype of lichen planus, a chronic inflammatory skin condition. LPF primarily affects the hair follicles and is characterized by small, itchy, papular eruptions that can be accompanied by hair loss. The exact cause of lichen planus is unknown, but it is thought to be related to an autoimmune response. In some cases, it may be triggered by medications, infections, or chemical exposure.
Lichen planus follicularis (LPF) is a rare and chronic skin condition characterized by the formation of small, scaly, and itchy papules on the scalp and neck. The exact cause of LPF is unknown, but it is believed to be an autoimmune disorder that affects the hair follicles. The condition can be difficult to diagnose and manage, and it is often misdiagnosed as another skin condition such as psoriasis, seborrheic dermatitis, or alopecia areata
Causes
Lichen planus follicularis is a type of hair loss condition that occurs as a result of an autoimmune response in the body. The exact causes of lichen planus follicularis are not well understood, but there are several theories that have been proposed to explain the underlying mechanism. In this article, we will explore the main causes of lichen planus follicularis in detail.
- Autoimmune Response
The most widely accepted theory is that lichen planus follicularis is caused by an autoimmune response in the body. In this scenario, the body’s immune system mistakenly attacks its own hair follicles, causing them to become inflamed and eventually destroyed. This results in hair loss and a characteristic pattern of bald patches on the scalp.
- Genetics
There is also evidence to suggest that genetics may play a role in the development of lichen planus follicularis. Some studies have found that the condition is more likely to occur in individuals who have a family history of autoimmune diseases, such as lupus or rheumatoid arthritis. This suggests that there may be a genetic predisposition to the development of autoimmune conditions that can increase the risk of lichen planus follicularis.
- Environmental Factors
Environmental factors, such as exposure to toxins or chemicals, may also contribute to the development of lichen planus follicularis. Some studies have found that individuals who work in industries that expose them to toxic chemicals, such as hairdressers or hair stylists, are more likely to develop the condition. Additionally, exposure to certain medications, such as beta-blockers, has also been linked to the development of lichen planus follicularis.
- Infections
Infections have also been proposed as a possible cause of lichen planus follicularis. Some studies have found that the herpes simplex virus may play a role in the development of the condition, although the exact mechanism by which this occurs is not well understood. Other infections, such as hepatitis C, have also been linked to the development of lichen planus follicularis, although the evidence is less clear in this case.
- Stress
Stress has also been proposed as a possible cause of lichen planus follicularis. Some studies have found that individuals who experience high levels of stress are more likely to develop the condition, although the exact mechanism by which this occurs is not well understood. Additionally, stress has been linked to the development of other autoimmune conditions, such as lupus, which suggests that it may also play a role in the development of lichen planus follicularis.
- Hormonal Imbalance
Hormonal imbalances have also been proposed as a possible cause of lichen planus follicularis. Some studies have found that women who experience hormonal imbalances, such as during menopause, are more likely to develop the condition. Additionally, hormonal imbalances have been linked to the development of other autoimmune conditions, such as lupus, which suggests that they may also play a role in the development of lichen planus follicularis.
- Nutritional Deficiencies
Nutritional deficiencies have also been proposed as a possible cause of lichen planus follicularis. Some studies have found that individuals who are deficient in certain nutrients, such as vitamin D or iron, are more likely to develop the condition. Additionally, nutritional deficiencies have been linked to the development of other autoimmune conditions, such as lupus, which suggests that they may also play a role in the development of lichen planus follicularis.
Symptoms
The main symptoms of LPF include:
- Hair loss: LPF causes hair loss in patches, which can be accompanied by itching and scaling. The hair loss is typically permanent, and the affected areas may remain bald.
- Scalp itching: Itching is a common symptom of LPF, and it may be accompanied by burning or pain. The itching is usually more severe in the affected areas.
- Scalp scaling: LPF causes scaling of the scalp, which is often accompanied by hair loss. The scaling is usually more severe in the affected areas.
- Scarring: LPF can cause scarring of the scalp, which can result in permanent hair loss. The scarring may be accompanied by itching and scaling.
- Papules and plaques: LPF can cause the formation of papules and plaques on the scalp, which are raised, red, and itchy. The papules and plaques may be accompanied by hair loss and scaling.
- Pustules: LPF can cause the formation of pustules on the scalp, which are pus-filled, red, and itchy. The pustules may be accompanied by hair loss and scaling.
- Nodules: LPF can cause the formation of nodules on the scalp, which are raised, red, and itchy. The nodules may be accompanied by hair loss and scaling.
- Pruritus: LPF can cause pruritus, which is an intense itching sensation. The pruritus may be accompanied by hair loss, scaling, and papules or plaques.
- Pain: LPF can cause pain in the affected areas, especially if the condition is accompanied by papules or nodules.
- Redness: LPF can cause redness of the scalp, which is often accompanied by itching and scaling.
LPF is diagnosed based on a physical examination and a biopsy of the affected skin. The biopsy is used to confirm the presence of LPF and to rule out other skin conditions that may cause similar symptoms.
Diagnosis
Diagnostic tests are crucial in helping to accurately diagnose and manage LPF. A combination of medical history, physical examination, and laboratory tests may be necessary to diagnose LPF. The following is a list of the most common diagnostic tests used to diagnose LPF:
- Physical examination: A dermatologist will examine the skin and hair for any signs of LPF, such as papules, scaling, and itching. The dermatologist will also look for any other associated symptoms, such as hair loss, dandruff, or redness and inflammation.
- Skin biopsy: A skin biopsy is a procedure in which a small sample of skin is removed and examined under a microscope. This test is used to confirm the diagnosis of LPF and to rule out other skin conditions.
- Scalp biopsy: A scalp biopsy is a procedure in which a small sample of scalp skin is removed and examined under a microscope. This test is used to confirm the diagnosis of LPF and to rule out other scalp conditions such as psoriasis or seborrheic dermatitis.
- Wood’s lamp examination: A Wood’s lamp examination is a test that uses ultraviolet light to examine the skin. This test can help differentiate between LPF and other skin conditions, as the ultraviolet light can cause the skin to fluoresce in different ways depending on the condition.
- Blood tests: Blood tests may be performed to rule out other conditions that may be causing the symptoms of LPF. These tests may include a complete blood count (CBC), erythrocyte sedimentation rate (ESR), and antinuclear antibody (ANA) test.
- Patch testing: Patch testing is a type of skin test that is used to determine if a person is allergic to a specific substance. This test may be performed if a person is experiencing symptoms of LPF that are not responding to other treatments.
- Hair analysis: Hair analysis is a test that involves examining a sample of hair to determine if there are any underlying problems with the hair or scalp. This test may be performed if a person is experiencing hair loss or other hair-related symptoms.
- Scalp scraping: Scalp scraping is a procedure in which a small sample of scalp skin is removed and examined under a microscope. This test is used to rule out other scalp conditions such as psoriasis or seborrheic dermatitis.
- Nail analysis: Nail analysis is a test that involves examining the nails for any signs of LPF, such as changes in the nail shape, color, or texture.
- Trichoscopy: Trichoscopy is a test that involves examining the hair and scalp using a special instrument called a dermatoscope. This test is used to evaluate the hair and scalp for any signs of LPF, such as changes in hair texture, color, or growth patterns.
The above diagnostic tests are important in helping to diagnose LPF and rule out other conditions. A combination of these tests may be necessary to accurately diagnose LPF and to develop an appropriate treatment plan.
Treatment
There is no cure for lichen planus follicularis, but there are several treatments that can help to manage the symptoms and prevent hair loss. The main treatments for lichen planus follicularis include:
- Topical corticosteroids
Topical corticosteroids are the first-line treatment for lichen planus follicularis. They work by reducing inflammation and itching in the affected area. Topical corticosteroids are usually applied directly to the scalp and come in the form of creams, ointments, or shampoos.
- Topical calcineurin inhibitors
Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, are also used to treat lichen planus follicularis. These medications work by suppressing the immune system and reducing inflammation in the affected area. They are usually applied directly to the scalp and come in the form of creams or ointments.
- Systemic corticosteroids
Systemic corticosteroids are oral or intravenous medications that are used to treat severe cases of lichen planus follicularis. These medications work by suppressing the immune system and reducing inflammation throughout the body. Systemic corticosteroids are usually only prescribed in cases where topical treatments have been ineffective.
- Phototherapy
Phototherapy is a treatment that uses ultraviolet light to improve the symptoms of lichen planus follicularis. Phototherapy is usually used in combination with topical medications and is performed in a dermatologist’s office.
- Antimalarial medications
Antimalarial medications, such as hydroxychloroquine, are sometimes used to treat lichen planus follicularis. These medications work by suppressing the immune system and reducing inflammation. Antimalarial medications are usually only prescribed in severe cases where other treatments have been ineffective.
- Immunosuppressive medications
Immunosuppressive medications, such as methotrexate and cyclosporine, are used to treat severe cases of lichen planus follicularis. These medications work by suppressing the immune system and reducing inflammation throughout the body. Immunosuppressive medications are usually only prescribed in cases where other treatments have been ineffective.
- Hair transplant surgery
Hair transplant surgery is a treatment option for lichen planus follicularis that is used to restore hair growth in areas of hair loss. The surgery involves removing hair follicles from one area of the scalp and transplanting them to the affected area. Hair transplant surgery is usually only performed in severe cases of hair loss.
- Topical minoxidil
Topical minoxidil is a medication that is used to treat hair loss. It is applied directly to the scalp and is thought to improve blood flow to the hair follicles, promoting hair growth. Topical minoxidil is sometimes used to treat lichen planus follicularis, but its effectiveness is not well established.
- Wigs or hairpieces
Wigs or hairpieces can be used to cover areas of hair loss caused by lichen planus follicularis. They are a cosmetic solution that can help to improve self-esteem and confidence in people with the condition.
Follicular Lichen Planus
