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A 4-mm punch biopsy that included hair follicles at the active edge revealed that this was a case of lichen planopilaris. LPP most commonly affects middle-aged women. It mostly occurs on the frontal and parietal scalp and causes follicular hyperkeratosis, pruritus, perifollicular erythema, a violaceous scalp, and scalp pain.
Oral, topical, or injectable agents can decrease symptoms of itching and inflammation and stop the progression of the disease. Unfortunately these agents cannot reverse the disease.
Since a lymphocytic infiltrate predominates in LPP, experts recommend starting with an oral anti-inflammatory agent such as doxycycline or hydroxychloroquine. Topical agents include high-potency corticosteroids or topical tacrolimus to the involved areas. Intralesional injections of triamcinolone acetonide 10 mg/mL may be helpful.
If severe symptoms and signs of activity persist after 3 to 6 months of doxycycline or hydroxychloroquine, then mycophenolate mofetil should be considered, as well as a referral to a dermatologist.
In this case, once the patient understood that there was no treatment that would bring back the hair on her bald areas, she decided to forego treatment.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Scarring alopecia. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:815-818.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
The Color Atlas of Family Medicine is also available as an app for mobile devices. See
A 4-mm punch biopsy that included hair follicles at the active edge revealed that this was a case of lichen planopilaris. LPP most commonly affects middle-aged women. It mostly occurs on the frontal and parietal scalp and causes follicular hyperkeratosis, pruritus, perifollicular erythema, a violaceous scalp, and scalp pain.
Oral, topical, or injectable agents can decrease symptoms of itching and inflammation and stop the progression of the disease. Unfortunately these agents cannot reverse the disease.
Since a lymphocytic infiltrate predominates in LPP, experts recommend starting with an oral anti-inflammatory agent such as doxycycline or hydroxychloroquine. Topical agents include high-potency corticosteroids or topical tacrolimus to the involved areas. Intralesional injections of triamcinolone acetonide 10 mg/mL may be helpful.
If severe symptoms and signs of activity persist after 3 to 6 months of doxycycline or hydroxychloroquine, then mycophenolate mofetil should be considered, as well as a referral to a dermatologist.
In this case, once the patient understood that there was no treatment that would bring back the hair on her bald areas, she decided to forego treatment.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Scarring alopecia. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:815-818.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
The Color Atlas of Family Medicine is also available as an app for mobile devices. See
A 4-mm punch biopsy that included hair follicles at the active edge revealed that this was a case of lichen planopilaris. LPP most commonly affects middle-aged women. It mostly occurs on the frontal and parietal scalp and causes follicular hyperkeratosis, pruritus, perifollicular erythema, a violaceous scalp, and scalp pain.
Oral, topical, or injectable agents can decrease symptoms of itching and inflammation and stop the progression of the disease. Unfortunately these agents cannot reverse the disease.
Since a lymphocytic infiltrate predominates in LPP, experts recommend starting with an oral anti-inflammatory agent such as doxycycline or hydroxychloroquine. Topical agents include high-potency corticosteroids or topical tacrolimus to the involved areas. Intralesional injections of triamcinolone acetonide 10 mg/mL may be helpful.
If severe symptoms and signs of activity persist after 3 to 6 months of doxycycline or hydroxychloroquine, then mycophenolate mofetil should be considered, as well as a referral to a dermatologist.
In this case, once the patient understood that there was no treatment that would bring back the hair on her bald areas, she decided to forego treatment.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Scarring alopecia. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:815-818.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
The Color Atlas of Family Medicine is also available as an app for mobile devices. See