From the Guidelines
LPP stands for Lichen Planopilaris, a rare inflammatory skin condition that causes scarring hair loss, however, based on the provided evidence, it is more likely that LPP refers to Lichen Planus, a condition that can be managed with high-potency topical steroids or tacrolimus, as recommended by the NCCN guidelines 1. The condition primarily affects the skin and mucous membranes, causing lesions and discomfort.
- The NCCN guidelines recommend the use of high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05%, or tacrolimus 0.1% ointment, for the management of lichen planus and lichenoid diseases 1.
- The choice of treatment formulation, such as gel, solution, or cream/lotion/ointment, depends on the affected area, with gel considered for mucosal disease, solution for scalp disease, and cream/lotion/ointment for all other affected areas 1.
- Additional treatment options, such as oral antihistamines, prednisone, and narrow-band UVB phototherapy, may also be recommended for the management of lichen planus and lichenoid diseases 1.
From the Research
Definition of LPP
- Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia that commonly presents with hair loss at the vertex or parietal scalp 2.
- LPP is a rare inflammatory disorder of unclear etiology that causes permanent scalp hair loss 3.
- It is considered to be a follicular variant of lichen planus, with clinical variants including classic LPP, frontal fibrosing alopecia, and the Graham-Little-Piccardi-Lassueur syndrome 4.
Characteristics of LPP
- Patients with LPP may experience scalp itching, burning, or tenderness, and hair loss is typically permanent due to scarring 2.
- A scalp biopsy shows a lymphocytic infiltrate involving the isthmus and infundibulum, with apoptotic cells present in the external root sheath and concentric fibrosis surrounding the hair follicle 4.
- The pathogenesis of LPP remains to be fully elucidated, but involves the irreversible destruction of hair follicle stem cells and loss of a hair follicle's capacity to regenerate itself 4.
Treatment of LPP
- The main goals of treatment are reducing symptoms and preventing disease progression and further hair loss 2.
- Treatment options include potent topical corticosteroids, intralesional corticosteroids, anti-inflammatory agents such as hydroxychloroquine, and immunosuppressive medications such as cyclosporine, mycophenolate mofetil, or systemic corticosteroids 4.
- A systematic review and Bayesian network meta-analysis found that the combination of clobetasol plus N-acetylcysteine and the combination of clobetasol plus pentoxifylline were significantly superior to clobetasol alone in reducing LPP activity index 5.
- Methotrexate and cyclosporine have also been used to treat LPP, with similar clinical efficacy at the end of the first month of therapy, although methotrexate was found to be better tolerated 6.