Do you also have bald spots and hair loss? Let's learn about this Lichen Planopilaris?

Are you also experiencing hair loss in some areas of your head, and sometimes your scalp feels red, itchy, or inflamed? Maybe you too would like to know about this condition called Lichen Planopilaris (LPP). Don't worry, we'll talk about it simply, in a way that you can understand. Just like talking to a friend.

So, what is lichen planopilaris (LPP)?

Simply put, lichen planopilaris (LPP) is an inflammatory condition that occurs in the hair follicles (the small holes where hair comes out of your scalp) on your scalp. Think of it this way: the small holes where hair comes out (the hair follicles) become a little "angry", red, and swollen. This is what we call 'inflammation' in medicine. Over time, this inflammation can lead to scarring where the hair follicles used to be, and the hair can be permanently lost, never to grow back again. This is most often seen on the scalp.

Who is more likely to develop this LPP?

This condition called LPP most often affects women between the ages of 40 and 60. However, that doesn't mean that men can't get it. It can develop in men and adults of any age. Therefore, it's difficult to think that it won't happen just based on age and gender .

How common is LPP?

Among scarring alopecia, LPP is considered the main cause. However, if we consider all the causes of hair loss (e.g. hormonal changes, nutritional deficiencies, hereditary baldness) together, LPP accounts for only a small percentage of people, about 1%, of all hair loss cases . Therefore, do not assume that everyone who loses hair has LPP.

What are the main types of LPPs?

Doctors have identified three main types of lichen planopilaris. These are slightly different from each other: 1. Classic lichen planopilaris: This is the most common type. It causes patches of baldness on the scalp, with a noticeable bald spot. 2. Frontal fibrosing alopecia: This causes bald spots and patches, especially on the forehead, near the hairline . It looks like the hairline is receding. Sometimes , eyelashes and eyebrows can also fall out in this type. 3. Lassueur-Graham-Little-Piccardi syndrome: Although the name may sound a bit long, this is another form of LPP. It is a bit more complicated. It causes bald patches on the scalp and hair loss in places like the armpits and groin.It is possible. Not only that, you may also see small rough bumps around hair follicles. Whatever the type, it is important to seek medical advice as soon as symptoms appear.

What are the symptoms of LPP? How do you recognize it?

Lichen planopilaris symptoms may appear suddenly in some people, while in others they develop gradually. If you have LPP, you may notice things like:

• The scalp may appear as patches of hair loss, resembling bald patches. There may be one or more of these.
• The skin on the scalp may be red, maybe a little thick, or it may look like it's peeling . It's like a bald spot , but a little different.
• You may feel a constant sensation of pain, itching, or burning in your scalp . This can be very bothersome for some people.

Imagine, when you comb your hair in the morning, you notice that there is more hair falling out than usual, or when you touch some parts of your head, the skin feels rough and feels like small bumps ... Maybe it's not just itching, but it can also burn. If you have these things, you need to be careful about it.

Importantly, LPP is actually a form of another skin condition called Lichen Planus . It is a condition that causes itchy, white patches on the hands, feet, and inside the mouth. Sometimes, there may be changes in the nails (e.g., rough, cracked, or streaked nails). About half of people with LPP also have lichen planus symptoms.

Why does this LPP occur? What is the reason?

This is a question that many people ask. "Why did this happen to me?" It's natural to wonder. To be honest, medical experts haven't found a single, definitive cause. But, according to current understanding, a type of cell called T-cells, which are part of our body's immune system , attacks the roots of our own hair follicles. Simply put, our body's defense system mistakenly starts destroying its own healthy hair follicles. In this way, diseases in which the body's immune system attacks its own cells are called autoimmune diseases . This is not anyone's fault, it's just a change in how the body works.

Is LPP a contagious disease?

No, absolutely not! This is something to keep in mind. Lichen planus is not a contagious disease. You cannot spread it to someone else through touch, breathing, or sharing things. So don't worry about it.

How does a doctor determine for sure that this is LPP?

If you think you have LPP symptoms, your first step should be to see a dermatologist. He or she can diagnose the condition in the following ways: 1. Physical examination: First, the doctor will carefully examine your scalp and skin. They will look at your hair loss, skin changes, and any scars. They will also ask about your complete health history and any other medications you are taking. 2. Dermoscopy: In this, the doctor uses a special light and magnifying device to look closely at the hair loss, the condition around the hair follicles, and any scars. This can provide a lot of information about the condition. 3. Skin biopsy: Since LPP can sometimes look like other skin conditions, this test is very important to confirm the diagnosis. This involves taking a very small piece of skin (usually a few millimeters) from the scalp under anesthesia, sending it to a laboratory and examining it under a microscope. This allows the doctor to see exactly what damage has been done to the hair follicles and whether there are any inflammatory cells. Only after these tests can the doctor say for sure whether you have LPP or another condition.

What are the treatments for LPP?

The good news is that there are several medications and treatments that can help control the symptoms of LPP and slow the progression of the disease. Because it is an inflammatory disease, most treatments aim to reduce inflammation and control the activity of the immune system . Your treatment plan may include one or more of the following:

• Corticosteroids: These are often the first line of treatment for controlling inflammation . They can be given as creams, lotions, pills, or even injections directly into the affected areas of the scalp (intralesional steroid injections).
• Hydroxychloroquine: This helps reduce inflammation in autoimmune diseases like LPP.
• Doxycycline ( Doxycycline ) or other antibiotics : These are sometimes used for their anti-inflammatory properties.
• Retinoids: These medications, made from vitamin A, help control skin cell growth. They can be given as pills or as a cream.
• Other immunosuppressants :In cases where the above treatments are difficult to control, stronger medications such as methotrexate and cyclosporine may be used. Your doctor will monitor you regularly when giving these.
• Low-level laser therapy (LLLT): Some studies have shown that using these special light waves may help with skin inflammation and hair growth to some extent.

Your doctor may give you one or more of these medications together. Sometimes the first medication you are given may not work as well. If that happens, don't worry. You can talk to your doctor and try another option. The most important thing is to keep trying until you find the treatment that works best for you and to take the treatment exactly as your doctor tells you.

What should you be careful about when living with LPP symptoms?

Living with LPP can be challenging at times, but with proper management, you can live well with the condition.

• Take your medication exactly as prescribed: Take the medication as prescribed by your doctor, in the correct dosage, at the correct time, and for the prescribed duration. Do not stop, increase, or decrease your medication without your doctor's advice.
• See your doctor regularly: See your dermatologist at regular intervals to see how the treatment is working, to check for any side effects, and to see if there are any complications.
• Consider your mental health: Hair loss and scalp discomfort can sometimes lead to low self-esteem, depression, or anxiety. This is normal. If you're feeling this way, talk to your family, friends, or doctor about it. You can also seek counseling if necessary.

Is there a way to prevent LPP from forming?

There is no known way to prevent LPP, as the exact cause is still unknown. However, if you notice any changes in your skin, such as hair loss, itching, or inflammation on your scalp, don't ignore it. Treating LPP early can help prevent future scarring and further hair loss.

Can LPP be completely cured?

This is also a problem that many people have. There is no known cure for LPP. That is, it is not a "cure and be done with." But don't worry! Treatment can stop it from getting worse and spreading further.You can control your symptoms, minimize scarring, and live a normal life. You may need to try several treatments to find the one that works best for you. Your dermatologist can help you on this journey and help you find solutions to your physical and emotional challenges.

How should I take care of my scalp when I have LPP?

Your scalp can be very sensitive when you have LPP. So to avoid scalp irritation, itching, or allergic reactions, consider these things:

• Use gentle shampoos and conditioners: Your doctor may recommend special shampoos and hair products. In general, it's best to use products that are hypoallergenic and gentle .
• Avoid products that contain these ingredients: It's best to avoid using shampoos and hair products that contain these ingredients, as they can make your scalp even drier, itchy, and redder:
• Alcohol: The label may say `(alcohol denatured)` or `(isopropyl alcohol)`.
• Fragrance or perfumes.
• Sulfates: (e.g. Sodium Lauryl Sulfate - SLS)
• Preservatives like `(parabens)` and `(methylisothiazolinone)`.
• Avoid scratching your scalp: No matter how much it itches, don't scratch it vigorously with your nails. This can cause injury, infection, and make the condition worse.
• Head covering: Some people use head coverings to cover their hair loss. Covering their head also helps protect their sensitive scalp from cold winds and harsh sunlight. You can also use scarves, hats, or even wigs, depending on your preference.
• If you are considering a wig, ask your doctor about places that make wigs for people with medical reasons. Also learn how to properly care for your wig. Don't let your wig get too tight, and it's a good idea to use a wig cap to protect your scalp and make it easier to put on.

When should I see the doctor again?

Even after you start treatment, you should see a doctor if:

• If the medication or treatment you've been given doesn't seem to be working , that is, if your symptoms aren't getting better.
• If the medication causes unwanted side effects .
• If your current symptoms worsen.
• If new symptoms (e.g. hair loss in new areas, increased pain) appear.

This condition, called LPP, does not usually cause serious, life-threatening health problems. Many people with the condition live normal, active lives. However, dealing with symptoms such as hair loss, pain, and itching can be emotionally difficult.Treatment can help with this. So don't give up hope. Work with your doctor to find a treatment that works for you, and talk openly about the physical and mental challenges you face. A headscarf, wig, or hat can help your self-confidence. But this is a very personal decision. When considering head covering, do what feels good and comfortable for you.

Finally, things to remember

• Lichen planuspilaris (LPP) is an inflammatory condition that affects the hair follicles on the scalp. It can cause scarring and permanent hair loss.
• Although the exact cause of this is not known, it is believed to be an autoimmune reaction . This is not a contagious disease.
• Symptoms may include patchy hair loss, redness, peeling, itching, and inflammation on the scalp.
• Early detection and treatment can help prevent the condition from getting worse and further hair loss. While there is no cure, there are effective treatments to control the symptoms.
• Take care of your scalp and use gentle shampoos .
• If hair loss is affecting your mental health, it's important to seek medical advice about that as well . You're not alone.
• Wearing a head covering (scarf, wig, hat) is a personal decision. Do what feels right to you.

I hope you find this information helpful. If you have any further questions, be sure to talk to your doctor.

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