Lichen Planopilaris Treatment | Scarring Alopecia Specialists Verona
Lichen Planopilaris (LPP): Treatment of Cicatricial (Scarring) Alopecia
Lichen planopilaris (LPP) is a chronic inflammatory condition of the scalp that leads to permanent hair loss (scarring alopecia). It was first described by Pringle in 1985 and is one of the primary causes of cicatricial alopecia, especially affecting middle-aged women.
Causes & Pathophysiology
The exact cause of LPP is still unclear. It is believed to be an autoimmune reaction targeting hair follicles, triggering inflammation and scar tissue formation that prevents hair regrowth.
Symptoms & Clinical Signs
LPP typically presents with:
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Irregular, atrophic patches of hair loss—often concentrated at the vertex
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Symptoms such as itching, burning, or pain on the scalp
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Perifollicular erythema and follicular hyperkeratosis (tiny scales or plugs around hair follicles)
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In active disease stages, the pull test may yield anagen hairs with thick root sheaths—an indication of ongoing inflammation
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In advanced areas, the scalp may look shiny, atrophic, and lacking follicular openings, characteristic of scarring alopecia
About half of patients also have cutaneous lichen planus, while roughly 10 % show oral or nail involvement.
Localization & Associated Manifestations
Although LPP primarily affects the scalp, it can occasionally involve body hair.
Diagnosis & Treatment Strategy
Diagnosing LPP relies on a combination of dermatologic evaluation, trichoscopy (hair and scalp imaging), and—when necessary—a skin biopsy.
The therapeutic goals are to halt disease progression, minimize symptoms, and preserve remaining hair. Treatment options include:
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Anti-inflammatory therapies (topical or systemic corticosteroids)
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Immunomodulatory medications
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Local supportive treatments to improve scalp health (like Topical Metformin – link)
Early diagnosis and regular dermatologic follow-up are crucial to limit further hair loss and preserve non-scarred areas
Trichology consultation with digital trichoscopy in Verona
At our medical clinic, you can book a trichology consultation in Verona with Dr. Fabrizio Presta. During the consultation, an innovative examination is performed: digital trichoscopy with videodermatoscope.
Thanks to the latest-generation technology, Fotofinder Universe 3, this device allows us to:
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Precisely assess the condition of the hair follicles
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Record detailed images of the scalp
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Monitor the progression of hair loss over time
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Produce the RFT (Trichological Photographic Report): a photographic documentation delivered to the patient, useful for tracking progress during therapy
Learn more about the main hair diseases
Find out more about the different types of alopecia and available treatments:
