From the Research
Trichoscopy is a valuable tool for differentiating between lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) of the scalp, with distinct features observed in each condition, as reported in a study published in 2020 1. The key trichoscopic findings in LPP include:
- Perifollicular scaling and erythema
- Tubular perifollicular casts (often described as "collar-like")
- Loss of follicular openings
- White dots representing destroyed follicles
- A characteristic peripilar white halo around existing hairs In contrast, DLE shows:
- More prominent follicular plugging
- Larger yellow-brown dots
- Thick arborizing blood vessels
- Red dots in a "honeycomb" pattern
- Scattered dark-brown pigmentation and larger areas of white structureless patches representing advanced scarring
- More diffuse and intense scalp erythema compared to LPP
- Telangiectasias and follicular red dots may be observed
- Blue-gray dots, characteristic of other forms of lichen planus, are typically absent in LPP These distinctions are crucial for accurate diagnosis and appropriate management, as treatment approaches differ between LPP and DLE, and have been further supported by studies using dermoscopy and reflectance confocal microscopy 2, 3, 4.