Lichen planopilaris: Causes and Treatments

Lichen planopilaris is both a primary scarring Alopecia and a variant of lichen planus (an itchy non-contagious skin condition). Lichen planopilaris occurs when the inflammation affects areas of skin that grow hair. It destroys the follicle and replaces it with scar tissue, destroying and preventing the hair from growing. There is no hard and fast rule, but the condition affects a far greater number of women than men. It seems to occur mostly in a person’s 40s and predominantly affects the Caucasian population. The condition is not contagious.

What causes lichen planopilaris?

It is not hereditary, although there are genes that increase your risk of developing the condition. What actually sets it off is not known.

Doctors have noted a link between T-lymphocytes, white blood cells, and lichen planopilaris. It appears to be linked to an overactive immune system, the hair loses its protection from the immune system and the follicles fall under attack.

Symptoms of lichen planopilaris

As with the other forms of scarring alopecia, redness and swelling are common. The scalp may turn scaly, and as the follicles are eventually blocked the hair may cease growing. Once this occurs, the scalp will become smooth and shiny.

Any area of the scalp may be affected. Patches of hair loss will be visible. The condition can occur in other areas of the body but this is not common.

How is lichen planopilaris diagnosed?

Similar to FFA, lichen planopilaris is diagnosed by examining a skin sample under a microscope. In order to take a sample, Dr. Khoza will perform a skin biopsy. You receive a local anesthetic by injection and a small scar may remain.

How is lichen planopilaris treated?

Hair that is lost cannot be regrown, as scar tissue is permanent. Therefore, the disease cannot be cured, but the symptoms can be reduced and treated, preserving the hair and slow the progress of the condition.

The condition generally resolves itself over time, it’s a matter of ensuring minimum damage is done in the time it is active.

The treatment protocols for this condition vary, as do their results. What works for one person may not work for another. Many people opt out of treatment and decide to wait for the condition to run its course. If you do want to have treatment, the options available include:

Topical corticosteroid preparations – these are effective at reducing redness and soothing the itch. It is important to ensure the lotion is only used on affected areas as it can cause thinning of the scalp.

Steroid Injections – this is usually used on small areas. It may uncomfortable and the possibility of adverse reactions should be discussed with Dr. Khoza.

Topical calcineurin inhibitor creams and ointments – effective at lowering inflammation levels in a local area, these applications treat the hair without side effects. It can sting a little when it is applied but this does not last long.

Oral corticosteroids – given for a very limited period, these tablets may reduce inflammation and so prevent hair loss. This treatment should be used as a short-term treatment while a long-term treatment effect is in motion. Long-term use can lead to adverse effects.

Oral low dose hydroxychloroquine – as mentioned above, this treatment works for some and shows no effect for others. The challenge is that it only shows results after 4-6 months of treatment. It does come with some risk – it needs to be given at a low dose. Long-term use is more effective for lichen planopilaris but increases the risk of side effects, which may include damage to the retina (the part of the back of the eye that detects light). Annual eye exams are recommended to monitor the health of the retina.

Immunosuppressive drugs – oral tablets to suppress the immune system can call to halt the attack on the hair follicles. The success rate of this medication varies greatly. It is safer than the corticosteroid tablets but does have other possible side effects. It is not safe for women who wish to fall pregnant, are pregnant, or lactating.

Antibiotics – antibiotics also show varying effects. They can offer great anti-inflammatory help.

Hair transplants and procedures – the condition generally runs its course and stabilises. However, relapse and recurrences of this condition is common. This limits procedures in these patients, as such hair transplantation is NOT yet an option for this inflammatory condition.

Lichen planopilaris

The effects of hair loss

Hair loss can be a very distressing experience, you may feel powerless and frustrated. It is important to ensure you have a good sense of moral and emotional support, and finding a new source of confidence through hobbies or interests may help, although it can be challenging to try new things. It is important to remember your dermatologist is here to support you through this journey and find the best way to combat the symptoms. The goal is to give you the greatest chance of maintaining full and lustrous hair growth.

Hair loss and scalp disorders with Dr. Nokubonga Khoza

Our hair loss and scalp disorders consultation take about 20-30 minutes. Only conditions relating to the scalp will be discussed during this session. All patients are expected to fill out a pre-assessment form on arrival to the practice. There are many causes of hair loss and scalp disorders and surprisingly they can look similar. Dr. Khoza’s primary goal is to provide the highest level of care when it comes to skin and scalp disorders. Our hair consults focus is on proper diagnosis, non-surgical management, counselling and preventing further disease progression.

During the consultation, Dr. Khoza will review the patients past medical history, medication, hair grooming practices, and styling. She will examine the scalp with the use of dermoscopy and take relevant pictures. Should there be a need; Dr. Khoza may order blood tests, take hair samples and perform a scalp biopsy. Dr Khoza performs the following in-office procedures for hair loss; Platelet rich plasma, micro-needling and intralesional injections.

Please note all procedures are scheduled for a separate appointment and are not performed on the same day as the initial consultation.

Estimated time for procedures:

  • Scalp biopsy – 20 minutes
  • Intralesional scalp injections – 10 minutes
  • Micro-needling – 30 minutes
  • Platelet Rich Plasma – 1 hour

How to prepare for your consultation with Dr. Khoza

  1. Take careful note of your symptoms. It is important to give Dr. Khoza an accurate description of what you have been experiencing. Has the hair been falling out gradually? Has it been only in certain patches, or has it been a constant and ongoing “loss” from all over the scalp?
  2. Think of any changes in your life that may coincide with the hair loss. Have you been taking a new medication, or have you stopped using a medication? Have you changed your level of physical activity? Have you gone through any major stresses, changed your diet, started or stopped taking any vitamins, or used a new hair or skin product, like shampoo?
  3. Be prepared for questions. Dr. Khoza will also want to know if hair loss runs in your family, and if so, at what age did your relatives experience hair loss for the first time?
  4. Dr. Khoza will examine your scalp during the consultation. Sebum, or oil, can sometimes play an important role in hair loss, so it may be advised to avoid washing your hair for a day or two prior to the appointment.
  5. Bring a list of medications used in the last two years.
  6. Bring your latest bloods if you have done any in the last six months.
  7. It always helps to bring all current hair and scalp products.
  8. Bring old photos up to 5 years prior if possible.
  9. Keep a positive outlook.


Improve the health of your scalp and hair with a comprehensive treatment plan designed for you. Contact Dr. Khoza and book your consult.