Lichen Planopilaris and Frontal Fibrosing Alopecia
What are Lichen Planopilaris and Frontal Fibrosing Alopecia?
Lichen Planopilaris (LPP) and Frontal Fibrosing Alopecia (FFA) are two types of irreversible hair loss conditions. They are both considered part of scarring alopecias.
Both conditions are autoimmune disorders. In these disorders, the immune system attacks hair follicles. This attack causes inflammation, scarring, and permanent hair loss.
Even though they are alike, it’s important to distinguish between the two conditions. They affect different areas of the scalp. Each condition requires a different treatment.
Lichen Planopilaris (LPP) is a type of lichen planus that affects the skin, mucous membranes, nails, and hair. The condition primarily targets the scalp, leading to patchy hair loss and scarring. The affected areas may show signs of inflammation, including redness and scaling.
Experts consider Frontal Fibrosing Alopecia (FFA) a subtype of LPP, but it has a distinct clinical presentation. FFA mainly causes hair loss at the front of the scalp, starting at the hairline and progressing symmetrically. It can also affect the eyebrows, eyelashes, and sometimes the body hair. Like LPP, FFA is a scarring alopecia, meaning that the hair loss in affected areas is permanent.
Why LPP and FFFA Happen?
In both LPP and FFA, the primary issue is an abnormal immune response. The body’s immune system mistakenly targets and attacks the hair follicles, leading to inflammation. This inflammation damages the hair follicles and results in scarring, which prevents new hair from growing.
The cause of this immune attack is unclear but may involve genes, hormones, and environmental factors. Researchers focus on finding what causes these immune responses and creating better treatments for these conditions.
What do LPP and FFA Look Like?
Lichen Planopilaris (LPP) presents with patches of hair loss scattered across the scalp. Inflammation may affect these patches, causing redness and scaling around the hair follicles. The scalp may show signs of scarring, appearing as white, shiny patches where the hair has permanently lost.
Patients often report symptoms such as itching, burning, or tenderness in the affected areas. The condition tends to progress slowly, with new patches of hair loss appearing over time. Patients may not notice hair loss at the initial onset of the condition, but they will complain of burning and itching.
Frontal Fibrosing Alopecia (FFA) leads to hair loss at the front of the head. This condition causes a receding hairline. FFA can also impact hair growth in areas like eyebrows, eyelashes, and body hair, not just the scalp. Patients may also experience symptoms such as itching or burning in the affected areas.
LPP and FFA can also affect fine, tiny hairs on the face called vellus hairs. You may see small, bump-like spots on the face where the skin gets darker, a condition called hyperpigmentation.
How are LLP and FFA Diagnosed?
Diagnosing LPP and FFA is difficult because they share similar signs with other types of hair loss. A careful clinical examination, often including trichoscopy and a scalp biopsy, is essential for an accurate diagnosis.
The dermatologist will examine the scalp for inflammation, scarring, and hair loss patterns. Redness and scaling around hair follicles may indicate LPP, while a band of hair loss at the front hairline is typical of FFA.
Trichoscopy is a valuable tool for examining the scalp in greater detail. Under magnification, LPP may show features such as perifollicular scaling, erythema, and a loss of follicular openings, indicating scarring. In FFA, trichosopy can reveal fewer hair follicles at the front of the hairline. It can also show redness around the follicles and no visible openings.
Doctors often require a scalp biopsy to confirm the diagnosis of LPP and FFA. The biopsy will typically show evidence of lymphocytic infiltration around the hair follicles, perifollicular fibrosis, and destruction of the hair follicles, leading to scarring.
Blood tests are not necessary for LPP and FFA, but they can help find other health problems that may affect treatment. When taking oral medications for LPP or FFA, blood tests are important. These drugs can cause serious side effects in the body. Regular monitoring through blood tests helps manage and mitigate adverse effects, ensuring the safety and efficacy of treatment plans.
Dermatologists utilize blood test results to adjust therapies and monitor patient health, providing a comprehensive approach to managing these scarring alopecias.
How Can LLP and FFA Be Treated?
Treatment for LPP and FFA focuses on reducing inflammation and preventing further hair loss. Once hair is lost, it typically cannot grow back. Early intervention is critical to minimize the progression of these conditions.
Topical treatments can help reduce inflammation and slow hair loss in mild cases of LPP and FFA. People commonly use topical corticosteroids to reduce inflammation, and they can apply them directly to the affected areas.
Other skin treatments include calcineurin inhibitors, such as tacrolimus and pimecrolimus. There are also topical JAK inhibitors. These treatments help control the immune response and reduce inflammation.
Intralesional injections with corticosteroids deliver medication directly into those spots. This approach can be particularly effective in reducing inflammation and slowing the progression of hair loss in LPP.
Oral Medications: In more severe cases of LPP and FFA, oral medications may be necessary to control the condition. Oral corticosteroids reduce inflammation. However, they are usually used for a short time. This is because they can have side effects.
Non-steroidal drugs can help manage the immune system. This can reduce hair loss over time. Examples of these drugs include doxycycline, hydroxychloroquine, methotrexate, cyclosporine, mycophenolate mofetil, and JAK inhibitors.
Regenerative treatments: Recently, platelet-rich plasma (PRP) injections have been shown to be an effective treatment for LPP, with high patient satisfaction rates. Low-Level Light Therapy (LLLT) is also a valuable addition to the treatment regimen and has been known for decades.
Can LPP and FFFA Be Cured?
LPP and FFFA can be controlled to prevent further hair loss, but once hair follicles are scarred, they don’t typically grow back. If doctors treat the condition early, they might improve the chances of some hair regrowth, but this is not always possible. Even when the disease seems to be under control, it can sometimes start progressing again.
Can Hair Transplants Be Performed in LPP and FFFA?
Hair transplant is an option for LPP and FFA if the disease has been stable for 1-2 years without medication. Stability is defined by the absence of active inflammation and disease progression. Sometimes, people with hair loss can get hair transplants if they are not getting much treatment and their condition stays the same.
In sum, Lichen Planopilaris (LPP) and Frontal Fibrosing Alopecia (FFA) are challenging scarring alopecias that require careful diagnosis and management. Hair loss from these conditions may not be reversible. However, early and effective treatment can help reduce inflammation. It can also stop further hair loss and improve the patient’s quality of life.
If you think you have LPP or FFA, you may contact our clinic for a hair loss consultation, diagnosis, and treatment. It’s important to have regular check-ups with a dermatologist, this helps monitor the progress of LPP and FFA.
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