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Lichen
planus
The exact cause of lichen planus is not known, but it may have
a significant autoimmune component as it is most frequently observed
in individuals who have other organ specific autoimmune diseases.
It is quite a common condition comprising up to 1% of cases in dermatology
clinics. It may occur at any age but most cases of lichen planus
develop in people between 30 and 70 years old.
There are several different types of lichen planus but the most
common type is papular lichen planus. This type usually presents
as papules on the skin that have a shiny, smooth flat surface. Over
time the papules can expand and coalesce to form plaques which can
be pink, violet or brown in color. The hair inside these plaques
can be lost. There are other less common forms of lichen planus
including; "actinic lichen planus" that is only found
in warm countries and only affects sun exposed areas, "lichen
planus spinulosus" that presents itself in various ways sometimes
with hair loss, and "occupational lichen planus" that
develops in people exposed to chemicals such as those used in color
film development. It is suggested that exposure to gold, mepacrine,
aminophenazole, beta-blockers, methyldopa, penicillamine, quinidine,
and quinine may play a role in promoting the lichen planus condition
for some people who are genetically susceptible to the condition.
"Lichen planopilaris" also called "lichen planus
follicularis" is a descriptive term given to any instance of
lichen planus where hair loss is associated with lichen planus papule
development.
Lichen
planopilaris
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A
lichen planopilaris affected human hair follicle with intense
inflammation present.
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Lichen Planopilaris is the specific name given to lichen planus
in a hair bearing region of skin (usually the scalp) that may cause
permanent, scarring alopecia. In fact, up to 40% of scarring alopecia
cases that a dermatologist will see are due to lichen planopilaris.
Lichen planopilaris presents primarily in middle-aged adults, but
there are case reports detailing lichen planopilaris in individuals
as young as 13 years old.
The hair loss caused by lichen planopilaris presents as distinct
patches of hair loss that may expand and coalesce over time. The
condition develops slowly such that even after several years of
the disease the patches of alopecia may be small and inconspicuous.
Lichen planopilaris is a poorly understood form of hair loss and
there is much confusion in distinguishing it from systemic lupus
erythematosus, frontal fibrosing alopecia, and another disease called
"mixed inflammatory destructive alopecia". Some dermatologists
claim that lichen planopilaris is the same as pseudopelade however,
the majority of dermatologists believe there are subtle distinctions
between the two diseases.
Skin biopsies are often employed when diagnosing Lichen planopilaris.
Within the skin there may be an abnormal infiltration of primarily
lymphocyte immune cells and deposition of immunoglobulins. Some
dermatologists may use direct immunofluorescence staining techniques
to look for antibody deposits in the affected tissue. Other dermatologists
have found that staining biopsy tissues with dyes specific for elastic
fibers significantly helps to diagnose lichen planopilaris from
other scarring alopecias. Simple biopsy staining procedures can
also help in identifying lichen planopilaris. Sometimes there is
inflammation around the affected hair follicles, especially in the
early stages of disease development, however, inflammation is not
always present. Despite the presence of an immune response, not
all dermatologists regard lichen planopilaris as an immune mediated
disease.
Typical treatment involves immunomodulation with a variety of drugs
similar to those used in the treatment of alopecia areata. The most
popular treatment methods involve use of corticosteroids. However,
the effectiveness of these treatments varies considerably from person
to person.
Lichen
planopilaris references
- Elston
DM, McCollough ML, Warschaw KE, Bergfeld WF. Elastic tissue in
scars and alopecia. J Cutan Pathol. 2000 Mar;27(3):147-52.
- Smith KJ,
Crittenden J, Skelton H. Lichen planopilaris-like changes arising
within an epidermal nevus: does this case suggest clues to the
etiology of lichen planopilaris? J Cutan Med Surg. 2000 Jan;4(1):30-5.
- Trueb
RM, Torricelli R. [Lichen planopilaris simulating postmenopausal
frontal fibrosing alopecia]. Hautarzt. 1998 May;49(5):388-91.
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S, Lee MS, Wilkinson B. Postmenopausal frontal fibrosing alopecia:
a frontal variant of lichen planopilaris. J Am Acad Dermatol.
1997 Jan;36(1):59-66.
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DA, Van Hale HM, Muller SA. Lichen planopilaris: clinical and
pathologic study of forty-five patients. J Am Acad Dermatol. 1992
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D, Bystryn JC. Immunofluorescence abnormalities in lichen planopilaris.
Arch Dermatol. 1992 Feb;128(2):214-6.
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a clinicopathologic study. J Am Acad Dermatol. 1990 Apr;22(4):594-8.
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of Brocq is lichen planopilaris: report of four cases that support
this nosology. Cutis. 1993 Feb;51(2):99-105.
- Smith WB, Grabski WJ, McCollough ML, Davis
TL. Immunofluorescence findings in lichen planopilaris: a contrasting
experience. Arch Dermatol. 1992 Oct;128(10):1405-6.
- Tosti A, De Padova MP, Fanti P. Nail involvement
in lichen planopilaris. Cutis. 1988 Sep;42(3):213-4.
- Horn RT Jr, Goette DK, Odom RB, Olson EG,
Guill MA. Immunofluorescent findings and clinical overlap in two
cases of follicular lichen planus. J Am Acad Dermatol. 1982 Aug;7(2):203-7.
- Waldorf DS. Lichen planopilaris. Histopathologic
study of disease. Progression to scarring alopedia. Arch Dermatol.
1966 Jun;93(6):684-91.
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