It is not invisible! A case report of 2 patients with scalp Lichen Planopilaris mimicking Androgenic Alopecia

Lichen planopilaris (LPP), a morphological variant of Lichen Planus known as specific of the scalp, is a rare, difficult-to-treat, chronic, inflammatory skin condition resulting in cicatricial alopecia, which can be eventually permanent irreversible [1]. It has been described for the first time by Pringle in 1895 [2] and placed in the lymphocytic disease group by the North American Hair Research Society (NAHRS) [3]. The causes of this disease are not well clarified but it seems to act as an autoimmune disorder probably triggered by drugs, metal exposure, stress, pollution, contacts sensitizers or infection [4]. Epidemiological data report that about 0.5-1% of the population is affected by Lichen Planus and in particular, adult women result as the most affected population by LPP (ratio 1.8:1) [5,7], on people aged between 40-60 years and more frequently in Caucasian and Indian population than Asian ones [7,8] Its typical manifestation is multifocal areas of alopecia on the central scalp, usually accompanied by perifollicular erythema, hyperkeratosis, and subjective symptoms such as pruritus or pain [9]. Three different variants of LPP are normally recognized [3,9]: classic LPP, frontal fibrosing alopecia (FFA) [10] and Graham-Little Piccardi Lassueur Syndrome [11]. A fourth variant, known as fibrosing alopecia in a pattern distribution (FAPD) could be added if considering some cases of patients with androgenetic alopecia in which lesions identical to those seen in LPP were found [12].Read more.....