Lichen Planopilaris Treatment
Of all the alopecias, both non-scarring and scarring, lichen planopilaris is the most difficult to treat. There have been no well-controlled trials documenting the benefit of any therapy in LPP. Since there is no possibility of regrowth in the scarred areas, the goal of treatment is to prevent enlargement of the scarred areas and to prevent new areas of inflammation from developing.
Several treatments have anecdotal support and are commonly tried in patients with LPP. These include superpotent topical steroids, intralesional steroids, and short courses of oral steroids. Doxycyline and tetracycline have been tried because of their anti-inflammatory effects. Plaquenil has been used because of its benefit in patients with discoid lupus erythematosus, another lymphocyte-mediated scarring alopecia. Isotretinoin, dapsone, and thalidomide have all been tried. The biologics are also being tried for LPP. In my experience, LPP waxes and wanes over time, probably without regard to treatment. At times, there seems to be improvement that coincides with initiation of therapy, but then the disease may worsen or new areas develop while on this same therapy.
It is likely that no therapy has been found that can influence the course of a patient’s LPP. Over time, LPP seems to burn out. This may take many years to occur and there may be widespread scarring alopecia before this happens. Many of my female patients with long-standing LPP wear wigs.