Lichen Planopilaris ( LPP )

A Guide for Patients Considering Hair Restoration

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What Is Lichen Planopilaris?

Last Updated: 27 Nov 2025

Lichen Planopilaris (LPP) is a rare but serious form of scarring hair loss caused by the body’s immune system mistakenly attacking hair follicles. Once destroyed, these follicles are replaced by scar tissue—and the hair will never grow back.

LPP is not just “thinning.” It’s permanent, progressive, and inflammatory—and one of the most common types of cicatricial (scarring) alopecia. It affects women about three times more often than men, typically appearing in middle age.

Because LPP can look like other forms of hair loss early on, it’s often missed or misdiagnosed—leading to delays in treatment and irreversible damage.

How Does LPP Present? Key Signs to Watch For

Unlike genetic hair loss, LPP causes active inflammation at the edges of bald patches. Common symptoms include:

Redness, scaling, or tiny bumps around hair follicles
Itching, burning, or tenderness on the scalp
Patchy hair loss, usually starting at the top (vertex) or sides (parietal) of the scalp
“Lonely hairs”: a few thick strands left behind in otherwise smooth, shiny bald areas
No visible pores or follicles in scarred zones

💡 Important: Early LPP may be subtle—but if you notice itching + thinning + redness, don’t assume it’s stress or aging. See a specialist.

LPP Isn’t Just One Condition — It Has Variants

LPP includes several related patterns:

Classic LPP: Irregular bald patches with inflamed borders
Frontal Fibrosing Alopecia (FFA): Band-like recession of the front hairline + eyebrow loss (a subtype of LPP)
Graham-Little Syndrome: Scarring scalp hair loss + non-scarring loss of underarm/pubic hair + skin rashes

All involve immune-mediated follicle destruction—and all carry the same warning: transplantation is extremely risky.

Why Diagnosis Must Come First — Before Any Treatment

LPP can mimic other conditions like seborrheic dermatitis, psoriasis, or even female pattern hair loss. But treating it like ordinary thinning can make things worse.

Essential diagnostic steps:

Scalp biopsy – taken from the active edge of hair loss (not the center!)
Trichoscopy (scalp magnification) – looks for perifollicular scaling, blue-gray dots, and absent pores
Medical history – including skin, nail, or mouth symptoms (lichen planus can affect multiple areas)

⚠️ Never consider a hair transplant without ruling out LPP first. Doing so could destroy your donor hair and accelerate loss.

Can You Get a Hair Transplant If You Have LPP?

Almost always — no. And even in rare exceptions, the risks are high.

❌ Hair transplantation is CONTRAINDICATED if:

You have any redness, scaling, itching, or pain on the scalp
Your bald areas are still expanding
A recent biopsy shows inflammation
You’ve had new hair loss in the past 2 years

Surgery during active LPP can trigger the Koebner phenomenon—where trauma (like graft insertion) causes new lesions and destroys both native and transplanted hair.

✅ Transplantation might be considered ONLY if:

The disease has been completely inactive for at least 24 months
A recent biopsy confirms no inflammation
You’re on stable medical therapy to keep LPP suppressed
The affected area is small and stable
You fully understand that graft survival may be low (often <40%)

Even then, studies show 50–80% of patients experience disease reactivation after surgery.

The Real Goal: Stop the Damage, Save What’s Left

Since lost hair can’t be regrown, treatment focuses on halting the immune attack.

Common Medical Approaches:

Topical steroids or calcineurin inhibitors (applied daily)
Steroid injections into active borders every 4–6 weeks
Oral medications: hydroxychloroquine (first-line), doxycycline, methotrexate, or mycophenolate
Symptom control: anti-itch therapies, gentle scalp care

Early, aggressive treatment offers the best chance to preserve remaining hair.

Monitoring Disease Activity

Your doctor may track:

Scalp photos every 3–6 months
Symptom diaries ( itching, pain, burning )
Clinical signs like redness or scaling
The LPP Activity Index ( LPPAI ) — a standardized scoring tool

Stability isn’t assumed — it must be proven over time.

The Emotional Impact

Living with LPP can be deeply distressing:

Grieving permanent hair loss
Fear of progression
Frustration with limited treatment options
Avoiding social situations or photos

Psychological support—through counseling or patient communities—can be as important as medical care.

When to See a Specialist

Seek evaluation from a dermatologist who specializes in hair disorders if you have:

Patchy hair loss with redness, scaling, or discomfort
Rapidly worsening thinning
Failed response to minoxidil or other standard treatments
Are being offered a hair transplant without a biopsy

Remember: In scarring alopecias like LPP, medical management comes first—surgery comes last (if ever).

Bottom Line

Lichen Planopilaris is a silent destroyer of hair follicles. While it can’t be cured, it can often be controlled — but only with early diagnosis and consistent treatment.

Hair transplantation is not a solution for active LPP — and may cause more harm than good. Your priority should be stopping the disease, protecting your remaining hair, and working with a specialist who understands the complexities of scarring alopecia.

Preserve. Don’t replace — until it’s truly safe to do so.

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Medical Disclaimers

Information provided on this website is for educational purposes only and is not intended as medical advice. It should not be interpreted as promotional material or as claims of superiority over other techniques or providers.

Individual results may vary, and no outcome can be guaranteed. Always consult with a qualified healthcare professional before making any decisions about medical treatment.

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