Lichen Planopilaris: Symptoms, Causes, and Treatment

Lichen Planopilaris is a rare inflammatory condition that affects hair follicles, leading to progressive scarring and permanent hair loss. Lichen Planopilaris originates from an autoimmune reaction where the body attacks its hair follicles, disrupting the natural growth cycle. The condition impacts the scalp and presents with symptoms such as burning, redness, and perifollicular scaling. Lichen planopilaris scalp shows patchy areas of scarring alopecia with no visible hair follicles. Itching, pain, and shiny bald patches are Lichen Planopilaris symptoms in severe cases, while milder cases exhibit mild discomfort, sensitivity, and gradual thinning. A biopsy and clinical observation are necessary to diagnose and treat the condition, which is treated with anti-inflammatory, corticosteroid, and immunosuppressant medications. Emotional distress, anxiety, and low self-esteem are recurring due to the visible nature of lpp hair loss, making psychological support part of the treatment.

Follicular lichen planus scalp must be distinguished from other causes of alopecia, such as androgenetic alopecia or telogen effluvium. Lichen planopilaris causes are not related to hormonal fluctuations or nutritional imbalances, but to an immune dysfunction. Lichen planopilaris symptoms differ in that the scalp appears inflamed, painful, or shows signs of scarring, compared to the gradual thinning seen in hereditary hair loss. Approaches to lichen planopilaris treatment differ, as non-scarring types respond to nutritional support, minoxidil, or hormone therapy. Scarring forms, such as lichen planopilaris, require immunomodulators to halt disease progression and protect remaining follicles.

What Is Lichen Planopilaris?

Lichen Planopilaris is a rare inflammatory scalp condition that destroys hair follicles, leading to permanent hair loss. The condition is classified as a type of lichen planus scalp disorder, distinguished by perifollicular redness, scaling, and irritation. Lichen planopilaris scalp involvement results in inflammation that gradually replaces hair follicles with scar tissue, leading to irreversible bald patches. The condition falls under LPP disease, which is linked to immune system dysfunction. LPP autoimmune responses involve T-lymphocytes mistakenly attacking hair follicles as if they were foreign structures.

The answer to the question “What is Lichen Planopilaris?” is that it is a form of follicular lichen planus that targets hair-bearing areas such as the scalp. Scalp tenderness, burning sensations, scaling around hair shafts, and visible follicular plugging are key characteristics of lichen planopilaris. Patients with patchy alopecia have a receding frontal hairline and a shiny, scarred surface. The damage to the follicular structure stops future hair growth in the affected areas. Dermatologists diagnose the condition through scalp examination and biopsy, confirming the presence of lymphocytic infiltrates and follicular damage.

Lichen planopilaris is a severe form of Scarring Alopecia, where inflammation destroys hair follicles and replaces them with scar tissue. The damage caused by scarring is permanent and irreversible, leading to bald patches. The scarring process prevents the regeneration of new hair, distinguishing lichen planopilaris scalp involvement from other hair loss conditions.

What Does Lichen Planopilaris on Scalp Look Like?

Lichen Planopilaris on the scalp looks like patches of hair loss surrounded by visible redness, perifollicular scaling, and noticeable inflammation. Affected areas appear with distinct follicular plugs or keratotic spikes during the early inflammatory phase. Red or purplish discoloration is present around the hair follicles, creating a mottled pattern that reflects an active immune response. Broken hairs or follicular dropout is visible in progressive stages, where the scalp skin becomes shiny, pale, and smooth due to permanent scarring.

The condition creates a pattern of patchy alopecia that spreads asymmetrically across the scalp. A flat, scar-like appearance results from the complete loss of follicular openings in advanced cases. The central parts of the affected patches show permanent damage, while the edges display active signs of inflammation. Close examination using trichoscopy reveals perifollicular erythema and scaling as consistent indicators of the condition. These visible characteristics distinguish lichen planopilaris regrowth from other hair loss disorders and are used to guide diagnosis and treatment planning.

What Does Hair Look Like Before and After Having Lichen Planopilaris?

The hair looks normal, dense, and evenly distributed before, but thinner, patchy, and permanently reduced after having lichen planopilaris. A healthy scalp surface that exhibits no signs of inflammation or scaling before the lichen planopilaris. The follicles function properly, allowing for regular hair growth cycles. The scalp appears clear without redness, irritation, or discomfort. Patients without scalp disease maintain hair volume and structure, with no signs of follicular damage or loss. The surface of the scalp holds a natural texture and color, indicating the absence of active inflammation.

Lichen planopilaris causes permanent follicular damage, resulting in hair that appears thinner, patchy, and reduced in density in affected areas. The affected regions of the lichen planopilaris scalp develop noticeable bald spots with smooth, shiny, scar-like skin replacing the natural follicular openings. Surrounding hairs appear inflamed with redness and scaling around the shafts before the hair is lost. The condition destroys the follicle, resulting in scarring and permanent baldness. The scalp exhibits symptoms of Scarring Alopecia, including skin tightening and loss of hair density, particularly in the central and frontal areas of the scalp. The changes are irreversible due to permanent follicular destruction caused by the underlying immune reaction related to LPP autoimmune activity.

What Are the Symptoms of Lichen Planopilaris?

The symptoms of Lichen Planopilaris are listed below.

• Scalp Redness: Scalp redness appears in inflamed areas where hair follicles are under attack. The symptom reflects an ongoing immune response and irritation. Red patches are found in areas of progressive hair loss.
• Perifollicular Scaling: Perifollicular scaling involves the presence of white or gray flakes surrounding hair follicles. The symptom indicates keratin buildup and inflammation. It signals damage to the follicular epithelium during active disease stages.
• Scalp Itching: Scalp itching is a lichen planopilaris symptom that is triggered by inflammation in the hair-bearing areas. The discomfort disrupts daily focus and signals active disease. Persistent itching worsens hair follicle damage.
• Scalp Burning Sensation: Burning sensations are caused by inflammation around the nerves in the scalp. The symptom reflects the immune system’s aggression toward hair follicles. It occurs in areas with recent hair shedding.
• Hair Fragility: Hair becomes fragile as follicles lose structural support from inflammation. Fragile strands fall out during brushing or light handling. The symptom marks a decline in follicular health.

What Are the Common Symptoms of Lichen Planopilaris?

The common symptoms of Lichen Planopilaris are listed below.

• Patchy Hair Loss: Patchy hair loss begins in small circular areas of the scalp. These areas expand as inflammation destroys more follicles. The pattern of loss reflects early-stage follicular scarring. Studies have highlighted that lichen planopilaris is a form of scarring alopecia characterized by progressive, permanent hair loss, starting as patchy areas that expand due to inflammation-driven follicular destruction. The information is based on the research study “Prevalence and Treatment Patterns in Patients With Lichen Planopilaris” by Natalia Pelet del Toro, Andrew Strunk, Amit Garg, et al., published on June 12, 2024.
• Perifollicular Erythema: Perifollicular erythema presents as redness around each hair follicle. Perifollicular erythema results from localized inflammation and capillary dilation. The sign is most visible in recently affected zones. Case studies found that perifollicular erythema contributed to presenting symptoms, occurring in 72% of patients, and was linked to localized inflammation and capillary dilation. The information is supported by the research “Lichen Planopilaris: A Retrospective Study of 32 Cases in an Australian Tertiary Referral Hair Clinic” by Karolina LS Kerkemeyer and Jack Green, published in 2018. 
• Scalp Tenderness: Scalp tenderness emerges as a response to ongoing immune-driven damage. Touching or combing the scalp causes discomfort and pain that worsens during flare-ups. Scalp tenderness in lichen planopilaris is linked to immune-mediated follicular damage, contributing to discomfort and progressive hair loss. The lack of standardized treatment in patients requiring long-term corticosteroid therapy to manage inflammation and tenderness is highlighted in “Prevalence and Treatment Patterns in Patients With Lichen Planopilaris.” The research was written by Natalia Pelet del Toro, MD, and published on June 12, 2024.
• Hair Shedding: Hair shedding accelerates during active inflammation. Hairs fall out in excess during washing or grooming. The sign signals active follicular destruction.
• Scalp Discoloration: Scalp discoloration appears in light or dark patches where inflammation has altered pigment. The symptom follows tissue damage and scarring. It becomes visible after hair loss reveals the affected skin. The study found that scalp discoloration results from tissue damage and scarring, appearing as light or dark patches once hair loss exposes the affected skin. The information is discussed in “A Practical Approach to the Diagnosis and Management of Classic Lichen Planopilaris” by Katerina Svigos, published on August 4, 2021. 

Lichen planopilaris symptoms vary based on age, gender, genetics, and health conditions. Middle-aged and postmenopausal women experience severe scalp itching, burning, and hair thinning due to hormonal shifts and immune sensitivity. Patients with autoimmune histories face earlier onset and rapid progression. Scalp tenderness, perifollicular erythema, and overlapping symptoms with thyroid disease and lupus, such as scarring and delayed treatment response, are expected in populations with heightened autoimmune prevalence.

What Are the Severe Symptoms of Lichen Planopilaris?

The severe symptoms of Lichen Planopilaris are listed below.

• Permanent Scarring Alopecia: Permanent scarring alopecia results from the irreversible destruction of hair follicles. The condition leaves smooth, shiny patches with no visible openings. Scarring prevents future hair regrowth in affected areas. Studies have highlighted that lichen planopilaris is a form of scarring alopecia that results in smooth, shiny patches with no visible follicular openings, which prevents future hair regrowth. The information is from research “Prevalence and Treatment Patterns in Patients With Lichen Planopilaris” by Natalia Pelet del Toro, Andrew Strunk, Amit Garg, et al., published on June 12, 2024.
• Complete Hair Loss in Affected Areas: Complete hair loss occurs when the immune response eliminates multiple follicles in one region. The sign reflects extensive tissue damage. Restoration of hair growth is no longer possible in these zones. The study “Scarring Alopecia: Symptoms, Causes, Diagnosis, Treatment” by Healthline (2024) describes how immune-mediated follicular damage eliminates multiple follicles, preventing hair regrowth in affected zones.
• Bleeding or Crusting Lesions: Bleeding or crusting lesions appear in advanced stages, resulting from skin breakdown. The wounds result from chronic inflammation and persistent scratching, requiring medical intervention to prevent infection.
• Widespread Inflammation Beyond the Scalp: Widespread inflammation affects eyebrows, body hair, and mucosal surfaces. The symptom signals systemic immune involvement. It reflects a more aggressive disease progression.
• Painful Sores on the Scalp: Painful sores form as inflammation disrupts skin layers around follicles. Inflammation in scarring alopecia leads to deep discomfort and secondary infections, signaling severe disease progression, as detailed in “Understanding Scarring Alopecia” by DermTrials (2025).

Lichen planopilaris severity is influenced by age, gender, genetics, and underlying health conditions. Hormonal shifts during menopause cause scalp inflammation and scarring, while autoimmune histories are associated with faster progression and poorer treatment response. The scalps of patients with lupus, thyroid dysfunction, or inflammatory skin disease are painful, causing rapid hair shedding and decreased healing potential. A case study examined 80 cases of lichen planopilaris, highlighting its clinical variability and the importance of early diagnosis in preventing irreversible follicular damage. The result highlights the role of dermoscopy and histopathology in distinguishing lichen planopilaris from other cicatricial alopecias, according to “Lichen planopilaris epidemiology: a retrospective study of 80 cases” in September 2015.

What Are the Rare Symptoms of Lichen Planopilaris?

The rare symptoms of Lichen Planopilaris are listed below.

• Involvement of Eyelashes or Beard: Lichen planopilaris rarely spreads to eyelashes or beard areas. Patchy hair loss affects the facial zones, suggesting an atypical distribution of immune attack.
• Nail Changes: Nail changes such as thinning, ridging, or brittleness are uncommon in the condition. The changes result from shared inflammatory pathways affecting keratin structures. Nail symptoms signal broader autoimmune disruption.  Research on lichen planus-associated nail abnormalities examines disruptions in keratin structure, linking them to broader autoimmune dysfunction. The details were described from the article “Lichen Planopilaris” by Dr. Delwyn Dyall-Smith, FACD, published in May 2022.
• Scalp Numbness: Scalp numbness occurs when nerve endings around inflamed follicles sustain damage. The symptom reduces sensation in the affected regions, indicating deeper tissue involvement.
• Facial Skin Involvement: Facial skin involvement is a rare form of frontal fibrosing alopecia, presenting as facial papules or patches of discolored skin. The symptom aligns with advanced immune-mediated progression. Study describes cases where patients exhibited perifollicular erythema, alopecic patches, and loss of follicular ostia, with histological findings indicating lymphocytic infiltration and basement membrane thickening, suggesting an advanced immune-mediated progression. The research is according to “Atypical Presentation of Lichen Planopilaris: Presentation of Two Cases and Review” by Nwanneka Okwundu, Felicia Ekpo, Jessica Ghaferri, and David Fivenson, published on March 16, 2020
• Unexplained Fever with Flare-Ups: Unexplained fever appears in rare systemic flares of lichen planopilaris. The immune system’s heightened activity causes mild body-wide symptoms. The condition requires close clinical monitoring. The research “A Practical Approach to the Diagnosis and Management of Classic Lichen Planopilaris” discusses systemic symptoms associated with lichen planopilaris, including scalp tenderness and burning sensations. 

Lichen planopilaris symptoms are complex and vary depending on age, gender, genetics, and underlying health conditions. The elderly experience persistent scalp tenderness and delayed healing, while postmenopausal women report eyebrow thinning and facial papules due to hormonal changes. Specific ethnic backgrounds are associated with prominent scarring, accompanied by minimal redness. Autoimmune predisposition increases the risk of nail involvement, mucosal lesions, ear discomfort, or skin pigment shifts in patients with thyroid disorders or lupus.

What Are the Stages of Lichen Planopilaris (LPP)?

The stages of Lichen Planopilaris (LPP) are listed below.

• Inflammatory (Active) Stage: The inflammatory stage begins with visible scalp redness, itching, and perifollicular scaling as immune cells attack hair follicles. Inflammation targets the follicular epithelium, triggering discomfort and early hair thinning. Trichoscopy reveals perifollicular erythema and hyperkeratosis. Early diagnosis allows treatment with anti-inflammatory medications to reduce symptoms and slow progression, although follicular damage is not yet reversible.
• Destructive (Progressive) Stage: The destructive stage is marked by accelerated follicular injury, increased hair shedding, and the spread of patchy alopecia. Hair loss becomes pronounced, and perifollicular signs such as redness and scaling begin to subside as follicles are permanently destroyed. Diagnosis shows fewer visible follicular openings and evidence of perifollicular fibrosis. Treatment helps reduce further damage, while lost follicles are unable to regenerate.
• Burnt-Out (Scarring) Stage: The burnt-out stage presents as smooth, shiny areas of permanent hair loss, distinguished by the absence of visible follicular openings. Inflammation resolves, but irreversible scarring replaces functional hair follicles, preventing any future regrowth. Diagnostic biopsies show complete follicular dropout and dermal fibrosis. The available treatments are scalp care and cosmetic solutions, such as wigs or hair transplantation in stable areas, which provide aesthetic support.

What Causes Lichen Planopilaris?

The causes of Lichen Planopilaris are a combination of autoimmune response and genetic predisposition, with immune dysfunction being the most common trigger. T-lymphocytes mistakenly attack the stem cells of the hair follicle in autoimmune disease, causing inflammation and permanent damage. The immune-driven mechanism presents a higher risk of scarring hair loss compared to rare causes such as medication reactions or viral infections. Autoimmune involvement, classified under LPP autoimmune, carries high chances of recurrence and progression, while drug-induced reactions are less persistent and tend to resolve after the withdrawal of the triggering agent.

Genetic influence, hormonal shifts, and environmental stressors are lesser contributors, but they contribute to disease development. For example, patients with a family history of lichen planus or other autoimmune disorders face a higher risk than patients exposed to short-term chemical irritants or scalp trauma. The autoimmune pathway, which leads to progressive follicular destruction, presents a permanent and severe outcome in contrast to the temporary effects caused by environmental factors. Scientific investigations continue to explore the specific triggers, but immune imbalance remains the leading cause linked to lichen planopilaris scalp damage and irreversible follicle loss.

What Are the Common Causes of Lichen Planopilaris?

The common causes of Lichen Planopilaris are listed below.

• Autoimmune Dysfunction: The immune system mistakenly attacks hair follicles, leading to inflammation and scarring that prevent normal hair growth. The study “Lichen Planopilaris – Causes, Symptoms, Diagnosis, and Treatment” by Apollo Hospitals (2025) discusses genetic predisposition, highlighting that individuals with a family history of autoimmune disorders are at an increased risk.
• Genetic Predisposition: A family history of autoimmune or inflammatory disorders increases the chance of developing lichen planopilaris. Specific genes related to immune regulation have been identified in patients with a diagnosis. The hereditary factor creates long-term susceptibility.
• Hormonal Imbalance: Hormonal shifts affect immune modulation and hair follicle behavior. Endocrine disturbances associated with thyroid conditions are relevant to the underlying mechanism. Hormonal imbalances in postmenopausal women and skin trauma contribute to disease onset, as noted in “Pathology Outlines – Lichen Planopilaris” by Pooria Zare and Mazaher Ramezani (2024)
• Skin Trauma or Irritation: Repeated injury, friction, or harsh scalp treatments contribute to inflammation that leads to lesion development. Trauma does not cause the disease but creates a favorable environment for autoimmune activation. Constant irritation weakens the scalp’s barrier function.

Common causes of Lichen Planopilaris vary with age, gender, demographics, genetics, and underlying health conditions, with middle-aged women, predominantly of Caucasian descent, showing the highest risk due to hormonal shifts and autoimmune susceptibility. Genetic predisposition increases risk in patients with a family history of autoimmune diseases, while coexisting conditions such as lupus or thyroid disorders influence disease onset and severity. Age-related hormonal decline and immune system changes heighten vulnerability in postmenopausal women.

What Are the Severe Causes of Lichen Planopilaris?

The severe causes of Lichen Planopilaris are listed below.

• Chronic Immune Overactivation: The prolonged overactivity of the immune system results in severe follicular damage. Hair loss becomes permanent, and inflammatory signs persist without improvement. The study “Review on: Lichen Planus” by Dr. Dipali S. Bolde et al. (2024) discusses T-cell-mediated immune responses, highlighting their role in prolonged inflammatory activity and follicular damage.
• Drug Reactions or Drug-Induced Autoimmunity: Anti-hypertensives or antimalarial medications have been identified as triggers. The compounds initiate immune responses that target skin and follicular tissue. Research found that medications for anti-hypertensives and antimalarials have been identified as triggers that lead to the development of lichen planopilaris. The drugs are believed to trigger immune responses that mistakenly target the skin and follicular tissue, leading to inflammation and subsequent scarring. The information is from the research “Drug-Induced Lichenoid Reactions: Clinical Spectrum, Pathogenetic Mechanisms, and Management” by  Thompson, R., and Gupta, V.  in January 2018.
• Systemic Inflammatory Conditions: Lichen planus or graft-versus-host disease contributes to lichen planopilaris through similar inflammatory pathways. The conditions amplify follicular destruction and prolong scalp inflammation. Long-term systemic inflammation decreases treatment responsiveness. Research on drug-induced lichen planus examines autoimmune pathways that contribute to follicular inflammation and scalp damage. Researchers have shown that prolonged immune activity reduces treatment effectiveness and recovery potential, as noted in “Drug-Induced Lichen Planus” by Krish Tangella, MD, MBA, published on May 22, 2018.

Severe cases of lichen planopilaris are influenced by age, gender, genetics, demographics, and underlying health conditions. Postmenopausal women experience heightened immune reactivity, leading to aggressive follicular destruction and extensive scarring, while patients with autoimmune predisposition face rapid disease progression and poor treatment response. Ethnic backgrounds with high inflammatory skin disease prevalence, such as Hispanic and South Asian populations, exhibit chronic inflammation.

Can Lichen Planopilaris on Scalp Lead to Permanent Hair Loss?

Yes, lichen planopilaris on the scalp can lead to permanent hair loss. The scalp condition causes inflammation around hair follicles, which triggers progressive follicular destruction. The scalp loses its ability to grow new hair once the hair follicles in areas become scarred. The inflammation creates perifollicular scaling, redness, and tenderness before the follicle closes off completely, leaving visible patches of smooth, bald skin.

Hair loss caused by LPP presents with specific symptoms such as burning, itching, or pain in the affected regions, which signal active inflammation. Hair shedding accelerates and becomes more apparent without medical intervention in areas with high stress, such as the crown and frontal scalp. Treatment helps manage symptoms and slow the progression, but restoration of lost hair remains unlikely once scarring has developed. Early recognition and intervention remain crucial to preserving unaffected follicles and limiting irreversible damage.

What Are the Treatments for Lichen Planopilaris?

The treatments for Lichen Planopilaris are listed below.

• Cognitive Behavioral Therapy (CBT): Cognitive Behavioral Therapy addresses the psychological stress linked to Lichen Planopilaris flare-ups. It reduces anxiety levels and helps lower inflammatory triggers, which supports medical treatments in controlling disease progression. CBT is recommended when emotional distress worsens symptoms or delays healing.
• Minoxidil: Minoxidil promotes hair regrowth by improving blood flow to the scalp and stimulating dormant follicles. It supports follicular density maintenance in early stages and is most effective when combined with anti-inflammatory treatments. Consistent application is needed, with visible results developing within three to six months.
• Stress Reduction: Guided breathing or meditation are stress reduction methods that influence cortisol levels, which in turn affect inflammation in Lichen Planopilaris. Controlled stress leads to a better hair loss treatment response and fewer relapses during prolonged flare-ups. Stress management becomes essential when emotional triggers worsen scalp irritation or hair loss.
• Immunotherapy: Immunotherapy modifies the body’s immune response to decrease follicular inflammation and scarring. Treatments include corticosteroids or calcineurin inhibitors, which suppress T-cell activity attacking hair follicles. Immunotherapy is necessary when the condition becomes aggressive or resistant to milder topical solutions.
• Platelet-Rich Plasma (PRP) Injections: PRP injections use concentrated platelets from the patient’s blood to stimulate healing and repair inflamed follicles. Clinical data suggest that PRP supports scalp recovery and extends remission when used in conjunction with immunosuppressive agents. PRP is indicated during early scarring phases to preserve existing hair and slow disease progression.

How Effective Is Hair Transplant for Treating Lichen Planopilaris?

Hair transplant is highly effective for treating Lichen Planopilaris. Hair transplant addresses random bald spots on the scalp caused by Lichen Planopilaris (LPP). The autoimmune condition leads to inflammation that damages hair follicles, resulting in scarring and permanent hair loss in affected areas. Hair transplantation becomes a viable option after the condition has been medically managed and the inflammation has remained inactive for an extended period. Affected areas are replanted with healthy hair follicles once disease activity has stabilized, through the use of anti-inflammatory or immunosuppressive medications. Success depends on factors such as the severity of scarring, the availability of donor hair, and the ability of the transplanted follicles to adapt to the altered scalp environment.

The procedure involves extracting healthy hair follicles from donor areas, such as the back of the scalp, and implanting them into bald patches where LPP has destroyed follicular units. The newly placed follicles are expected to grow hair naturally in the new location, while the density is limited due to the reduced blood supply in scarred tissue. The results of hair transplants improve when the disease has remained inactive for at least one to two years, lowering the risk of follicular damage after transplantation. Patient expectations must align with realistic outcomes, where improvements in appearance and coverage are possible.

Patients choose to undergo hair transplant procedures in Turkey due to cost-effectiveness, skilled specialists, and advanced technologies. Clinics in Istanbul and other major cities offer packages that include accommodation, transportation, and post-operative care. Vera Clinic stands out among the most reputable options for its experienced medical staff, patient-centered services, and consistently high satisfaction ratings. Selecting Vera Clinic provides access to FDA-approved techniques, a multilingual staff to support international patients, and customized aftercare programs to promote long-term success.

What to Expect Before and After an Lichen Planopilaris Hair Transplant

Expect a thorough medical evaluation before and after a Lichen Planopilaris hair transplant to confirm disease inactivity, followed by visible improvements in scalp coverage in stabilized scarred areas. The patient must undergo a detailed medical evaluation before undergoing a hair transplant for Lichen Planopilaris. Dermatologists use scalp biopsies, trichoscopy, and clinical observation to determine stability. Patients are expected to discontinue certain medications that interfere with healing and follow a preoperative care plan established by the specialist. The choice of transplant method, such as Follicular Unit Extraction (FUE) or Follicular Unit Transplantation (FUT), depends on the availability of donor hair, the extent of scarring, and the patient’s health. Setting realistic expectations is needed since results are influenced by scar tissue density and blood supply.

Mild swelling, temporary redness, and a healing period vary according to the skin’s response and graft placement. Hair transplants tend to shed during the healing process before starting a new growth cycle. Complete results begin to appear several months later, with gradual thickening occurring over time. The results of Lichen planopilaris hair transplant before-and-after comparisons show that coverage of the scalp has improved, confidence has increased, and the density of the hair is natural-looking when the condition has remained dormant. Regular follow-up visits, scalp care routines, and prescribed medications help maintain transplant success and reduce the risk of disease reactivation. Proper post-transplant care helps sustain long-term follicular health and visual improvement.

When to See a Dermatologist for Lichen Planopilaris

A patient must seek a dermatologist as soon as signs of scalp irritation, persistent itching, or patchy hair thinning develop, and the scalp appears inflamed or painful. The presence of burning sensations, perifollicular scaling, or noticeable redness around hair follicles indicates active inflammation, which leads to permanent follicular damage if untreated. Delaying medical assessment results in scarring that blocks regrowth and worsens hair loss over time.

Severe symptoms that require immediate dermatological attention include rapid hair shedding in localized areas, pain while touching the scalp, and visible bald patches with shiny or pale skin. The signs indicate progression to the destructive or burnt-out stages of lichen planopilaris, where the condition severely affects scalp structure. The symptoms reflect active inflammation and permanent follicular damage. Evaluation by a board-certified specialist in LPP dermatology becomes necessary when scalp pain, redness, and scarring begin to progress rapidly.

Early diagnosis through scalp biopsy or trichoscopy conducted by professionals in LPP dermatology helps reduce complications, maintain existing hair, and stabilize further follicular loss. Targeted treatment supports the management of Scarring Alopecia and prevents additional irreversible damage. Prompt action improves the long-term outcome by halting the autoimmune destruction linked to LPP disease. Early recognition of warning signs allows for effective intervention, preserving scalp health and limiting the progression of lichen planopilaris scalp damage.

When to Take a Hair Analysis for Lichen Planopilaris

Take a hair analysis when lichen planopilaris presents with unexplained or rapidly progressing hair loss, especially when accompanied by scalp discomfort, visible follicular redness, or unusual scaling around hair shafts. The test becomes essential when clinical symptoms are unclear or when other hair disorders need to be ruled out. Inflammatory damage not visible to the naked eye impacts follicular health, and a close examination of hair shafts under magnification provides critical insights into structural abnormalities.

Hair analysis becomes more urgent if hair loss is patchy, persistent, or accompanied by scalp tenderness, thinning in frontotemporal zones, or discoloration of surrounding skin. The method allows dermatologists to detect miniaturized, dystrophic, or broken hairs, supporting a diagnosis of active lichen planopilaris. A hair transplant consultation helps assess follicular viability and determine whether surgical restoration is a viable option. Early analysis, combined with scalp biopsy and trichoscopy, helps define the severity of follicular destruction and guides decisions on anti-inflammatory treatments or long-term scalp care strategies.

How Lichen Planopilaris Diagnosed?

The methods of diagnosing Lichen Planopilaris are listed below.

• Clinical Evaluation: A clinical evaluation involves a physical examination of the scalp to identify inflammation, redness, scaling, and patterns of hair loss associated with lichen planopilaris. A dermatologist checks for perifollicular erythema and follicular hyperkeratosis, which are consistent with scarring alopecia. The step is necessary at the initial stage to determine the likelihood of inflammatory scalp disorders.
• Trichoscopy: Trichoscopy is a non-invasive imaging technique that utilizes a dermatoscope to magnify and assess scalp and hair structures. The method reveals lichen planopilaris symptoms such as perifollicular scaling, broken hairs, and absence of follicular openings. Inflammation and follicular damage are visualized during trichoscopy diagnosis, eliminating the need for immediate biopsy.
• Scalp Dermoscopy: Scalp dermoscopy provides a detailed surface view of the scalp, enabling the distinction between lichen planopilaris and other causes of hair loss. It identifies features such as blue-gray dots, white patches, and perifollicular discoloration. Dermoscopy is useful during follow-up or when observing treatment response.
• Scalp Biopsy: A scalp biopsy involves removing a small section of the affected area, typically 4 mm in diameter, for microscopic analysis. The sample is taken from the edge of an active lesion in lichen planopilaris to capture inflammatory changes and early scarring. The procedure is required when visual and clinical signs are inconclusive.
• Histopathology Findings: Histopathology findings refer to the microscopic examination of the biopsy sample to confirm the diagnosis of lichen planopilaris. It shows perifollicular lymphocytic infiltration, basal cell damage, and destruction of follicular epithelium. The level of analysis contributes to reaching a definitive diagnosis and ruling out similar scarring conditions.

Can Home Remedies Treat Lichen Planopilaris?

No, home remedies cannot treat lichen planopilaris. Lichen planopilaris is a rare inflammatory disorder that causes permanent hair loss by destroying hair follicles through an autoimmune response. Patients consider natural remedies for lichen planus, such as aloe vera, coconut oil, or turmeric, to soothe general skin inflammation. These ingredients have no proven effect on halting or reversing follicular damage caused by Lichen planopilaris. The home remedies relieve mild irritation, but do not address the immune-driven process that underlies lichen planopilaris.

Medical treatment requires prescription-based therapies to reduce inflammation and preserve unaffected follicles. Corticosteroids, calcineurin inhibitors, and systemic immunosuppressants are prescribed based on the severity and progression of the disease. Relying solely on natural solutions instead of clinical care leads to delayed intervention, which increases the risk of irreversible scarring and permanent hair loss. Professional diagnosis, regular follow-up, and a structured treatment plan remain essential for managing symptoms and slowing the progression of the disease.

What Shampoos Are Best for Treating Lichen Planopilaris?

The shampoos best for treating Lichen Planopilaris are listed below.

• Ketoconazole: Ketoconazole is an antifungal agent that reduces inflammation and helps manage scalp conditions associated with immune system activity. It is effective in controlling Malassezia yeast overgrowth, which is related to inflammatory scalp disorders. Regular use of ketoconazole shampoo alleviates redness, itching, and follicular irritation.
• Zinc Pyrithione: Zinc pyrithione provides antibacterial and antifungal support, which helps calm scalp irritation and reduce flaking.  Zinc pyrithione is used in shampoos designed to treat seborrheic dermatitis and other inflammatory scalp conditions. The product is able to restore microbial balance, making it a suitable choice for treating chronic scalp inflammation caused by Lichen Planopilaris.
• Salicylic Acid: Salicylic acid works by gently removing dead skin cells and softening scaly patches, without damaging the surrounding tissue. Salicylic acid improves scalp cleanliness and prepares the skin for medicated treatments. The keratolytic action reduces follicular blockage and supports a healthier scalp environment.
• Coal Tar: Coal tar slows down the excessive shedding of skin cells and reduces inflammation. Coal tar shampoo relieves itching, thickened plaques, and persistent scaling in Lichen Planopilaris.  It has been traditionally used for treating psoriasis and other scaly scalp disorders due to its antiproliferative effects. 
• Ciclopirox: Ciclopirox is an antifungal agent that contains anti-inflammatory properties.  Ciclopirox targets fungal organisms while modulating immune responses that contribute to hair follicle destruction. The result is that it reduces the microbial load and the autoimmune activity associated with Lichen Planopilaris.
• Selenium Sulfide: Selenium sulfide reduces scalp oil production and controls fungal organisms that contribute to irritation. Selenium sulfide helps maintain a balanced scalp microbiome and diminishes inflammation caused by overactive sebaceous glands. The soothing properties of its skin care products make it beneficial for reducing redness, flaking, and itchiness.
• Clobetasol Propionate (in shampoo form): Clobetasol propionate is a potent corticosteroid that reduces immune-mediated inflammation in the scalp. Shampoo formulations deliver targeted relief to affected areas without systemic side effects. It is prescribed in short courses to suppress flare-ups of Lichen Planopilaris.
• Piroctone Olamine: Piroctone olamine is an antifungal compound that is less irritating than some alternatives and helps relieve itching and scaling. Piroctone olamine supports scalp health by preventing microbial imbalance and reducing follicular inflammation. Regular use helps soothe chronic irritation and supports the skin’s barrier function.
• Tea Tree Oil (in medicated shampoos): Tea tree oil has natural antifungal, antibacterial, and anti-inflammatory properties that support scalp health. Tea Tree Oil helps soothe itching and reduce microbial triggers involved in autoimmune scalp reactions. Shampoos containing tea tree oil offer a natural alternative or complement to pharmaceutical agents.

What Are the Signs of Hair Regrowth After Lichen Planopilaris Treatments?

The signs of hair regrowth after Lichen Planopilaris treatments are listed below.

• Appearance of Fine, Soft Hairs: New growth starts as fine, colorless vellus hairs on previously affected areas of the scalp. The hairs indicate early signs of lichen planopilaris regrowth when inflammation has been reduced. The appearance of soft texture suggests that follicular activity has resumed.
• Reduced Scalp Redness and Irritation: Visible decrease in redness, scaling, and tenderness signals that inflammation has subsided. A calm scalp environment allows follicles to resume normal function. The improvement in scalp condition supports new hair growth.
• Increase in Hair Density Over Time: The gradual thickening of the treated area indicates that hair shafts are transitioning from vellus to terminal hairs. Higher density reflects follicle recovery after interventions such as platelet-rich plasma (PRP) or immunotherapy. A denser scalp surface means the treatment is responding effectively.
• Slower Hair Shedding: Noticeable reduction in the number of strands lost during washing or brushing suggests improved follicle strength. Stabilized shedding supports the shift from active inflammation to repair. The stabilization is an early indicator that the scalp is recovering.
• Reappearance of Pigmented Hair in Bald Patches: The return of pigmented, darker hair in previously bald spots signals reactivation of melanocytes and follicular function. The change reflects success in reversing some damage caused by inflammation. The shift from pale fuzz to pigmented strands confirms sustained regrowth.

What Are the Different Types of Lichen Planopilaris?

The different types of Lichen Planopilaris are listed below.

• Classic Lichen Planopilaris: Classic Lichen Planopilaris is a chronic, non-contagious autoimmune condition that primarily affects middle-aged women, causing irreversible scarring alopecia and patchy hair loss at the crown or vertex due to inflammation and destruction of the follicles.
• Frontal Fibrosing Alopecia (FFA): Frontal Fibrosing Alopecia is a progressive, non-contagious autoimmune condition primarily impacting the frontotemporal hairline in postmenopausal women, causing permanent scarring hair loss linked to hormonal influences and emotional distress.
• Graham-Little-Piccardi-Lassueur Syndrome (GLPLS): Graham-Little-Piccardi-Lassueur Syndrome is a rare, non-contagious autoimmune disorder characterized by non-scarring hair loss in the axillae and groins, keratotic papules on the trunk and limbs, and progressive follicular damage that impacts appearance and emotional well-being.

1. Classic Lichen Planopilaris

Classic Lichen Planopilaris is a chronic inflammatory condition that leads to scarring alopecia. It is a prevalent form of lichen planopilaris, primarily affecting middle-aged women, while men experience it rarely. Alopecia frontal, Lassueur-Graham-Little-Piccardi syndrome, and other variants of the disease are characterized by patchy hair loss occurring at the crown or vertex. The condition results from an autoimmune response, where T-cells mistakenly attack hair follicles, causing inflammation and irreversible follicle destruction. Classic Lichen Planopilaris is not contagious and does not spread through contact. The progressive damage results in permanent bald patches, affecting scalp health and hair density.

2. Frontal Fibrosing Alopecia (FFA)

Frontal Fibrosing Alopecia is a progressive form of scarring hair loss that affects the frontotemporal hairline. It is increasingly diagnosed in postmenopausal women and has become more prevalent than classic Lichen Planopilaris in dermatology clinics. The linear band-like pattern of Lichen Planopilaris differs from the patchy pattern of classic Lichen Planopilaris on the scalp. The underlying cause is believed to involve an autoimmune response, with hormonal influences suspected as contributing factors. Scarring hair loss caused by Frontal Fibrosing Alopecia is not contagious and cannot be transmitted through physical contact.  The condition leads to permanent hair loss, affecting scalp density and facial appearance, which results in emotional distress.

3. Graham-Little-Piccardi-Lassueur Syndrome (GLPLS)

Graham-Little-Piccardi-Lassueur Syndrome is a rare variant of Lichen Planopilaris distinguished by a triad of symptoms affecting the scalp, body, and hair-bearing regions. It is the least common form and primarily affects middle-aged women, with fewer reported cases in men. GLPLS condition differs from Lichen Planopilaris and Frontal Fibrosing Alopecia in that it involves non-scarring hair loss in the axilla and groin, along with keratotic papules on the trunk and limbs. The exact cause remains unclear, but an autoimmune mechanism is suspected, leading to progressive follicular damage. The disease is not contagious and does not spread through contact. The condition leads to permanent hair loss, visible skin changes, and cosmetic concerns, which impact physical appearance and emotional well-being.

How Does Lichen Planopilaris Differ from Other Types of Hair Loss?

Lichen Planopilaris differs from other types of hair loss by its unique characteristics related to inflammation and scarring. Alopecia androgenetica is characterized by gradual thinning without scarring, while lichen planopilaris results in permanent damage to hair follicles due to inflammation. The results in scarring alopecia, where hair follicles are destroyed and replaced by scar tissue, leading to irreversible hair loss. The presence of redness and scaling on the scalp is distinct from non-scarring types of hair loss, such as telogen effluvium or alopecia areata.

Lichen planopilaris presents with symptoms such as itching or burning sensations, which differ from the painless hair loss experienced in other kinds of hair loss conditions. The pattern of hair loss stands out, as it appears in small, irregular patches rather than diffuse thinning or a defined pattern seen in other forms. Lichen planopilaris is considered an autoimmune disorder, in which the body’s immune system attacks hair follicles, whereas androgenetic alopecia is a genetic and hormone-driven condition. Inflammation, scarring, scalp changes, symptomatic discomfort, and an autoimmune origin distinguish lichen planopilaris as a distinct form of hair loss that requires tailored treatment approaches.

The comparison of Lichen Planopilaris differs from other types of hair loss is shown in the table below.