Lichen planopilaris (Lichen planopilaris (LPP))

Lichen planopilaris (LPP) is the most common primary lymphocytic scarring alopecia in adults. It produces patches of progressive hair loss with perifollicular redness, scaling, and frequently itching, burning, or tenderness in active areas. Smooth scarred-looking areas without visible follicular openings appear as the disease progresses.

Frontal fibrosing alopecia (FFA) is now considered a clinical variant of LPP, with similar histology and overlapping treatment.

Diagnosis requires dermatology assessment, trichoscopy (perifollicular erythema, scaling, casts), and often a scalp biopsy showing characteristic lichenoid inflammation around the upper follicle.

Treatment aims to halt progression and reduce inflammation. Standard options include high-potency topical and intralesional corticosteroids, hydroxychloroquine, doxycycline, methotrexate, mycophenolate mofetil, and increasingly JAK inhibitors in resistant cases. Hair already lost will not regrow because the follicle stem cells have been destroyed; protecting the remaining follicles is the realistic goal.