The Diagnosis and Treatment of Lichen Planopilaris (LPP) Related Hair Loss

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Michael Beehner:

How is Lichen planopilaris diagnosed? Is it just a visual diagnosis or are there tests?

The clinical picture and a biopsy are the usual ways to to diagnose Lichen planopilaris (LPP). It is thought to probably be of an autoimmune etiology. It can sometimes overlap with Alopecia Areata in its clinical appearance, but the hair loss is usually more “splotchy” with multiple, small patches irregularly spread all over the head, including in the donor area. It leaves a “scarring alopecia” result, which means that in each of these little bald patches there are no pores or follicular elements of any sort.

We usually wait at least two years after any sign of disease activity (enlarging, redness, scaling) before considering hair restoration surgery. Some hair transplant surgeons will then perform a repeat biopsy to make sure there are no lymphocytes present around nearby follicles near the edge of these lesions before transplanting. When the diagnosis has already been confirmed before a patient reaches me, I will often give the patient the choice between re-biopsying or doing test grafts. The good news about this diagnosis, as opposed to alopecia areata, is that it often will “burn out” and remain inactive for a long time or for that patient’s life span.

I have transplanted around 10 of these patients and have only had one re-activate. The treatment is steroid injections in the scalp in the area affected. Frontal fibrosing alopecia, which affects mainly the front hairline, beard or eyebrows is thought to be a sub-type of LPP.

Mike Beehner, MD

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
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