Lichen planus follicularis capillitii L66.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

lichen planopilaris; lichen ruber follicularis

Definition
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Lichen planus follicularis of the capillitium.

The Lichen planus follicularis capillitii can occur either:

  • isolated as topographically defined "minus variant" of the lichen planus follicularis (most common)
  • as partial manifestation in combination with a Lichen planus mucosae (see figure)
  • as partial manifestation of a classical Lichen planus
  • (more rarely) as partial manifestation of a generalized lichen planus follicularis

Manifestation
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w:m=8:2; people between the ages of 40 and 60 years are preferentially affected.

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Clinical features
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The skin changes mostly appear as chronic (smouldering), passagger itching, not very sharply defined redness (a plaque character - palpable elevation - cannot be proven in most cases) with rather little scale. Typical are peripilary scaling that distally encloses the hair shaft with the image of "lonely hairs".

The parietal regions, the vertex area, and less frequently the fronto-temporal areas are affected.

Tufted hairs can occur but are (in contrast to folliculitis decalvans) rather rare.

Clinically important is the evidence of scarring (absence of follicular ostia; see also alopecia, scarring; see also Lassueur-Graham-Little syndrome) as well as the exclusion of other scarring alopecia (e.g. lichen planopilaris - usually associated with keratosis pilaris - or lupus erythematodes chronicus discoides).

Histology
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Mostly dense, perifollicular lymphocytic infiltrate with vacuolar degeneration of the follicular epithelium.

Direct Immunofluorescence
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Mostly dense, perifollicular lymphocytic infiltrate with vacuolar degeneration of the follicular epithelium.

Therapy
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Early treatment to prevent the formation of scarred alopecia.

External therapy
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Potent glucocorticoid tinctures such as 0.2% triamcinolone/2% salicylic acid skin spirit R262, Volon A tincture, Betnesol-V crinale. Intralesional injection of individual foci with triamcinolone acetonide crystal suspension(only moderate success).

Internal therapy
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According to the Lichen planus.

Literature
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  1. Baibergenova A et al (2013) Lichen planopilaris: update on pathogenesis andtreatment
    . Skinmed 11:161-165
  2. Gupta SN et al (2003) Lichen planopilaris presenting as truncal alopecia: a case presentation and review of the literature. Cutis 72: 63-66
  3. Lyakhovitsky A et al (2014) A case series of 46 patients with lichen planopilaris: Demographics, clinical evaluation, and treatment experience. J Dermatologist Treat 26: 275-279
  4. Mehregan DA et al (1992) Lichen planopilaris: Clinical and pathologic study of forty-five patients. J Am Acad Dermatol 27: 935-942
  5. Mirmirani P (2003) Short course of oral cyclosporine in lichen planopilaris. J Am Acad Dermatol 49: 667-671

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020