Lichen Planopilaris Cicatratial Alopecia

Definition:   Cicatratial Alopecia is a diverse group of hair disorder occurs rarely and destroys the hair follicles permanently followed by scar formation and ultimately it causes hair loss. 

Description: It has the following characteristics for the better understanding.

1) Hair loss may occur with severe itching, pain and burning and progresses rapidly. In some cases it happens gradually with any above mentioned features and even not noticed for a long period of time. 

2) Its also known as Scarring Alopecia which occurs in all age groups.

3) Some signs of inflammation may be present in cases like redness, scaling, increased or decreased pigmentation , pustules etc. 

4) It occurs mostly in female in compare to male.

5) It affects 30-60 yrs of age group people.

Classification: Scarring Alopecia is classified into 2 major categories. A) Primary B) Secondary

A) Primary Cicatratial Alopecia:In Primary Cicatratial Alopecia hair follicles are primarily involved for destruction internally.It is further classified as per involvement of inflammatory cells that destroy the hair follicles. Inflammation majorly involve lymphocytes &  neutrophils. Followings are lymphocytic cicatratial alopecia.

1)Lichen Planopilaris; 2) Frontal Fibrosing Alopecia 3)Central Centrifugal Alopecia and 4) Pseudopelade(Brocq).

And  neutophillic Cicatratial Alopecia are 1) Folliculitis declavans and 2) Tufted Folliculitis. Its seen that Lymphocytic Cicatratial Alopecia is happening in a greater number in compare to Neutrophilic Cicatratial Alopecia and its ratio is like 4:1 so its basically it happening 4 times more.Lymphocytic Cicatratial Alopecia affects the middle-aged women while Neutrophilic Cicatratial Alopecia affects middle-aged men. 

B) Secondary Cicatratial Alopecia: In Secondary Cicatratial Alopecia destruction to the hair follicles is not follicular process by internal means , its due some external injury like severe infection, burns, radiations etc.

So, here comes the Lichen Planopilaris that we will discuss in detail, which is first Lymphocytic Primary Cicatratial Alopecia. 

                            Lichen Planopilaris 

Definition: Lichen Planopilaris is a primary cicatratial alopecia & mainly found in adult and especially in females. Its seen between age group of 25 to 70 yrs. Children are not majorly involved and all races are susceptible. 

                    

Sites: The the commonest sites for Lichen Planopilaris are front, sides and lower back of the scalp.

Discoverer: It was originally first time described by Pringle in the year 1889. 

Aetiology:The cause of the Lichen Planopilaris is unknown . It is an auto-immune disorder where lymphocytes are mainly involved for destruction of follicular cells.

Pathogenesis:Its a T-cell disorder with increased CD8:CD4 ratio. Some drugs also trigger this condition like gold, quinacrine hydrochloride but cause is not known exactly.

Clinical Features: Classic type of Lichen Planopilaris has  those features through which we can easily diagnose this condition. 

Sign:-

1)Inflammation & hyperkeratosis are commonly present.

2)There is maculo-papular lesion with oozing 

3)Hair Pull Test is positive for indicating the active stage. Hair loss may be limited or extensive.

4)The affected area of the scalp becomes smooth & shiny when hairs are destroyed.

5)Facial & body hairs are rarely affected.

Symptoms:-

1)There may be severe itching & burning in the affected area of the scalp..

2)When it starts, there is no involvement of hairs but when it advances and scar has been formed, alopecia occurs.

Diagnosis:Basically diagnosis can be made on the basis of 2 process. First is clinical examination & second laboratory examination like punch biopsy of the affected skin of the affected area.

Differential Diagnosis: Today most of the doctors especially the dermatologist are not able to diagnose the condition so we have to be very clear about how to differential Lichen Planopilaris from the other similar conditions like Folliculitis Declavans, Alopecia Areata, Seborrheic Dermatitis, Central Centrifugal Alopecia. 

Histopathology:In the early stage, Lymphocytic lichenoid interface dermatitis may be seen and it affects directly the infundibulam & isthmus of the hair follicle. Along with this there is accumulation of scattered dyskeratotic and necrotic keratinocytes in basal layer and colloid bodies in adventitial dermis. This is accompanied by infundibular hyperkeratosis, hypergranulosis and atrophy or absent of sebaceous glands. And typical lichen planus seen in epidermis. 

Now with progression of this disease lichenoid infiltrate distributed peripherally by the way of fibrroplasia and that is seen around  atrophic squamatized follicular epithelium. Following the follicular destruction, there is maker foreign body hair-shaft granulomas and that's the hall mark of Cicatratial Alopecia. When we stain deeply a intracellular material of a section with heamotoxylinoeasin, eosinophillic bodies ate found like colloid or hyaline in nature. And these colloid materials fully occupied the cell and makingg disappearance of nuclei or shrunken or become pyknotic. These bodies are generally present in epidermis. Many of them contained basophilic dots or masses appearing like pyknotic & fragmented nuclei.

Medical Treatment: As I always say, there are many modes of treatment available in our great country India for any kind of diseases.

But people mostly prefer to take it from Old School of Medicine(Allopathy) as their first choice and when some percentage of them do not get any satisfied results , they would take a move to other options available in medical field.

Yes, here we are talking about the world's 2nd largest practising system of medicine called Homoeopathy.But it does not mean that you should not take Old School of Medicine in your first choice because here I am just expressing the people's thought that I have been seeing in my day to day practice.

Homoeopathy has a great scope for treating the every kind of disease for last 200 years. And had been giving the wonderful satisfied results so Lichen Planopilaris can be also treated & managed very well in Homoeopathy.And yes, it does mean that you would get hairs back in your area of scalp from where it has gone due to the scar formation.

Medically there are many treatments available in market as of now with different names as per the different company establishments but motive of  all those treatments available in the medical field is only to give a better management to stop the further progression of the disease.

Following ones you may opt after getting suggestion from a Trichologist. So, before opting any kind of treatment you should have a proper consultation with Dr.

As we know Lichen Planopilaris is a type of Primary cicatratial Alopecia which is also called Scarring Alopecia so basically its treatment should be started from very early stages otherwise once the scar formation has done, then there is no any chance to regrow hairs in that scared area of the scalp. So, only treatment can slow down the rate of progression and ultimately symptomatic treatment is advised.So,basically  following treatments are recommend

1)Anti-inflammatory Drugs: First of all anti-inflammatory treatment is recommended for Lichen Planopilaris, which are as follows:-

a)Corticosteroids

b)Hydroxychloquine

c)Tetracycline

d)Methotrexate

So, these are the common anti-inflammatory drugs that can used but response to the treatment varies from patient to patient. 

2) Hair Transplantation: This option is only opted when a large area of scalp is involved or it has progressed to a greater degree and involve the larger space of the scalp but it would not be so successful that's why it is very rarely by any of the doctor. But make sure the disease was under remission of 2 years. 

3) Topie or Hair Piece: This is the only option suggested by a Trichologist when more than 2/3 portion of scalp is affected. Topie is now frequently used in those persons also where have the hair loss from Male Pattern Baldness 

Myths: Like in other cases there are also some myths about the Lichen Planopilaris. It is believed to be a contagious but actually its not. 

                     *HaveGoodHair & LiveGoodLife*