Lichen Planopilaris, Dijagnosis and Therapy Challenge - Case Report

Abstract

Background: Lichen planopilaris is relatively rare inflammatory disorder that results in cicatricial alopecia. It is a rare, cutaneous form of lichen planus which affects hair follicles, most commonly on the scalp area. It is caused by an autoimmune disorder that leads to follicular destruction and permanent hair loss. Case history: We are presenting the case of a patient who is 21 years old and who suffers from cicatricial alopecia and follicular hyperkeratosis of the parietal region of the scalp. Initially, she was diagnosed with seborrheic dermatitis and has been treated with local corticosteroid therapy for several months by her doctor. She was admitted to the Department of Dermatology with lessions located on the scalp. A clinical examination revealed exudative erythema with prominent circumferential hair follicle openings and the presence of sticky, yellowish crusts and scales whose removal caused bleeding. There were a several locations with significant cicatricial alopecia which look like porcelain. Dermoscopy showed perifollicular squamas. Routine laboratory analyses and immunological analysis were in normal range. Finally, after taking a biopsy and histopathological findings, we have come to a differential diagnosis which may include fibrous and suppurativ follicular disorders, as well as lichen planopilaris. The patient was treated with keratolytic lotions, combination of corticosteroid preparation and salicylic acid applied topicaly, and tacrolimus 1% cream which was used twice per day for several months. This terapy was successful, crusts did not return and progression of the disease was stopped.