From the Guidelines
Lichen planopilaris management should prioritize high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05%, or tacrolimus 0.1% ointment, as recommended by the NCCN guidelines. The goal of treatment is to halt disease progression, reduce inflammation, and prevent permanent hair loss.
Treatment Options
- High-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05%, or tacrolimus 0.1% ointment, are recommended for all grades of lichen planus and lichenoid diseases 1.
- Oral antihistamines, prednisone, and narrow-band UVB phototherapy (if available) are also recommended for managing lichen planopilaris 1.
- Solution can be considered for scalp disease, and cream/lotion/ointment for all other affected areas 1.
Additional Considerations
- Patients should avoid hair treatments that could exacerbate inflammation, including harsh shampoos, heat styling, and chemical processing.
- Regular follow-up every 3-6 months is essential to monitor disease activity and treatment response, with the understanding that lichen planopilaris is often chronic and may require long-term maintenance therapy to prevent recurrence. The most recent and highest quality study, the NCCN guidelines (2024), provides the basis for these recommendations 1.
From the Research
Lichen Planopilaris Management
- Lichen planopilaris (LPP) is a condition that causes scarring hair loss due to immune-mediated inflammation, resulting in atrophy and scaling 2.
- The key to preventing irreversible hair loss is diagnosing and starting treatment at the earliest possible stage 2.
- There is no definite cure for LPP, making therapy challenging 2.
Treatment Options
- Platelet-rich plasma (PRP) has been shown to be a new and effective choice for the treatment of LPP, with significant reduction in LPPAI scores and high patient satisfaction 2.
- Topical clobetasol 0.05% is also effective in reducing LPPAI scores, but its efficacy decreases over time 2.
- Other treatment options include topical corticosteroids, calcineurin inhibitors, vitamin D analogs, and phototherapy modalities, as well as systemic corticosteroids and systemic retinoids 3.
- High-dose clobetasol propionate 0.05% has been shown to be effective and well-tolerated in cutaneous lichen planus, with a high rate of complete remission 4.
Treatment Approach
- An individualized therapeutic approach is recommended, taking into account the type, extent, and severity of the disease 3.
- A step-by-step approach to treatment, starting with standard modalities and ranking alternative systemic treatments according to efficacy, evidence level, and side-effect profile, is proposed 3.
- The main goals of treatment are reducing symptoms and preventing disease progression and further hair loss 5.
Challenges and Limitations
- The literature has limited evidence on treatments for LPP, and most available evidence is from case reports and case series 5.
- The evidence shows a varied response to therapy, with frequent reports of poor response 5.
- Further research is needed to develop effective treatments for LPP and to improve patient outcomes 2, 5.