GLPLS-Cicatracial Alopecia

 Definition: It is a rare lymphocytic primary cicatratial alopecia defined by lichenoid dermatosis of the scalp. Non-cicatratial alopecia of axilla & groin present with lichen planus eruption on scalp, body or both. 

Discovery: It was first time came into light by Piccardi in the year 1913 and then after him 2 years later Erns Graham Little was the person who discovered it his patient. 

Description

1)Graham -Little-Picarrdi-Lasseur -Syndrome(GLPLS) is a variant of the lichen planus but with follicular presence and that's why called follicular lichen either scalp, body or both.

2)Oral cutaneous lichen is also one of the important features. And it is present in all most 50% of patients. 

3) Its a triode of multifocal cicatratial alopecia of scalp, non-cicatratial alopecia of axilla and groin & follicular lichen planus eruption on scalp, body or both.

4) GLPLS is sporadic and nonfamilial. 

5) It affects women 4 times more in compare to men , especially middle-aged & post menopausal. 

Aetiology: As we have seen in Lichen Planopilaris which is an auto-immnue disease mediated by T-cell so same in case of GLPLS. But exact cause is unknown. And there are some considerable hypothesis for its aetiology:- 

1)Immunological:- Among the subtype of HLA, HLA-DR is majorly associated with GLPLS. HLA antigens are hypothesised to enhance the T-cell immune response with unknown cause. 

2)Viral:-Hepatitis-B virus is associated with GLPLS. And its a very rare condition as I have told that only one case had been reported so far. Hepatitis-B virus vaccine is hypothesised and then there is stimulation of immune response which triggered the lichen planus eruptions. 

3)Hormonal:- It is associated with non-cicatratial alopecia of axilla & groin.

4)Others:- Neuropsychological stress. Vitamin deficiency especially A , premenopausal and postmenopausal women are more likely to have this disease. 

Clinical Feature:

1)In most of the reported cases, GLPLS patients are generally females and mostly they are middle-aged one like 30-60 yrs. This disease affect the white women more in compare to other races. 

2)Cicatratial alopecia of the scalp is chronic one which has the following features:-

    a)Mild perifollicular erythema with or without pruritus.

    b)Follicular hyperkeratosis

    c)Patches with tufts of present sometime.

    d)Loss of residual normal tufts & hair follicle.

    e)Clinically permanent hair loss . 

3)Non-cicatratial alopecia of axilla, groin, sometime eye brows with follicular lichen planus eruption on skin ,scalp or sometime both. 

4)Patients have a history of cutaneous oral lichen planus.

5)It may be also associated with liver disease because one case may be reported with HepatitisB. But its not a frequently reported so I am not sure about it association with liver and all. 

Histology:

There is sign of inflammation and then inflammatory lichenoid infiltrate is seen near the junction of infundibulam & isthmus of follicle. This is observation during the early stage. Infundibulam & isthmus junction is called infundibuloisthmic region where stem cells are present a d these stem cells are responsible for generation of lower 2/3 part of hair follicle. Now during the end stage atrophic dermis, fibrosed empty shafts can be seen. And there is also keratinous follicular plugs with loss of sebaceous glands. 

Lichenoid lymphocytic infiltrate mostly composed of CD8 & CD4 T-cells which irreversibly damage the stem cells & hair follicles. 

Histologically, GLPLS is completely different due to present of lesions at the end stage from other lymphocytic cicatratial alopecia.

Diagnosis:A complete history and physical examination of the patient should be done. By the evaluating the history of the patient we can determine the significant hair loss, psychological stress and underlying endocrine causation. 

A full body physical exam should be done including the skin and axilla and pubic area examined for non-cicatratial alopecia. 

Trunk and extremities examined for the hyperkeratotic papules along with perifollicular erythema which is the key sign of GLPLS. 

Scalp examination may reveal the patchy cicatratial alopecia.Anagen Hair Pulling Test would be positive because of loosely attached hairs on the scalp. 

Skin biopsy along with physical exam will make a confirmatory diagnosis. Skin biopsy shows the perifollicular area of inflammation and Pilosebaceous destruction causing the GLPLS. 

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 GLPLS 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 GLPLS 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.

Cyclosporine, thalidomide and metronidazole are frequently advised for its treatment 

                    *HaveGoodHair & LiveGoodLife*