What Explains This Woman’s Symptoms?

Answer: Lichen planopilaris

Results of a biopsy confirmed the clinical diagnosis of lichen planopilaris. This inflammatory disease is characterized by lymphocytic destruction of the hair follicle that results in scaling, atrophy, and scarring alopecia, which in this patient’s case is demonstrated by loss of the hair follicles. Lichen planopilaris most commonly affects women between the ages of 40 and 60 years. Characteristic perifollicular erythema is usually seen at the periphery of the lesions. This condition is notoriously resistant to treatment. Mainstay therapy involves topical, intralesional, and/or systemic corticosteroids. Nonsteroidal treatment options typically take months to elicit a response.

Alopecia areata is not inflammatory or scarring. Seborrheic dermatitis is not scarring and rarely results in alopecia. Trichotillomania manifests with broken-off hairs and is not scarring. Androgenetic alopecia is asymptomatic and without inflammation.

David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.