Lichen Planopilaris: Symptoms, Causes & UK Treatment Guide

Lichen planopilaris (LPP) is a specific type of primary scarring alopecia, meaning it causes permanent hair loss by destroying the hair follicle and replacing it with scar tissue. In the UK, it is clinically recognised as a follicular variant of Lichen Planus, a condition that usually affects the skin or mucous membranes. While ordinary hair loss like male pattern baldness is non-inflammatory, LPP involves the body's immune system attacking the hair follicles.

The condition is more common in women than in men and typically develops between the ages of 40 and 60. Because the hair loss is cicatricial (scarring), the hair cannot grow back once the follicle is destroyed. This makes early identification and management by a healthcare professional essential to preserve as much hair as possible.

Lichen planopilaris often presents as patchy hair loss on the scalp, but it can occasionally affect hair on other parts of the body. Unlike common thinning, LPP is frequently symptomatic. Patients often report:

• Intense Pruritus: A persistent, bothersome itch on the scalp.
• Scalp Pain or Burning: A stinging or tender sensation when touching the hair or scalp.
• Perifollicular Scaling: Small flakes of skin or 'sleeves' that wrap around the base of individual hair shafts.
• Redness (Erythema): Inflammation and redness visible around the hair follicles.
• Smooth Patches: As the condition progresses, the scalp may appear shiny and smooth where hair follicles have been lost, with no visible pore openings.

The exact cause of Lichen planopilaris is not fully understood, but it is widely categorised as an autoimmune-mediated disorder. The body’s T-lymphocytes (a type of white blood cell) mistakenly attack the skin cells within the hair follicles. Why this happens is still being researched, though experts believe it may be a combination of genetic predisposition and environmental triggers.

In the UK, LPP is sometimes associated with other forms of Lichen Planus, such as those affecting the mouth or nails. There are also specific subtypes, such as Frontal Fibrosing Alopecia (FFA), which causes a receding hairline and loss of eyebrows, and Graham-Little-Piccardi-Lassueur Syndrome. While LPP is not contagious, it can be a long-term, relapsing condition that requires ongoing monitoring.

Diagnosis usually begins with a physical examination of the scalp, often using a dermatoscope (a specialised magnifying tool) to look for scaling and redness around the follicles. According to British Association of Dermatologists (BAD) and NHS guidelines, a scalp biopsy is often required to confirm the diagnosis and rule out other causes of hair loss like discoid lupus or alopecia areata.

Treatment focuses on halting the inflammatory process. Common UK treatment pathways include:

• Topical Corticosteroids: High-potency steroid creams or gels to reduce local inflammation.
• Intralesional Steroid Injections: Injecting corticosteroids directly into the affected patches to calm the immune response.
• Oral Medications: In more severe cases, medications such as hydroxychloroquine or immunosuppressants like ciclosporin may be prescribed under specialist supervision.
• Calneurin Inhibitors: Non-steroid creams like tacrolimus may be used to reduce scaling and itching.

If you notice patches of hair loss accompanied by scalp irritation, itching, or redness, you should seek medical advice promptly. When you speak to a GP online, you can provide a detailed history of your symptoms and share clear photographs of the affected areas. While an online doctor cannot perform a biopsy, they can assess the likelihood of an inflammatory condition, offer advice on managing symptoms like itching, and provide the necessary referrals to a dermatologist for definitive diagnosis.

Seeking a treatment for LPP UK consultation early is the best way to prevent extensive scarring. An online doctor can also help monitor the psychological impact of scarring hair loss, providing support or sick notes if the condition is causing significant distress or affecting your ability to work.

Managing LPP is not just about medication; it also involves gentle scalp care. Patients are advised to avoid harsh chemical treatments, excessive heat styling, and tight hairstyles that put pressure on the follicles. Using mild, fragrance-free shampoos can help reduce irritation. Because LPP can be a chronic condition, many patients find support groups through organisations like Alopecia UK helpful for navigating the emotional challenges of permanent hair loss.