INTRODUCTION
Graham-Little-Piccardi-Lasseur Syndrome (GLPLS) is a rare clinical subtype of lichen planopilaris (LPP) that manifests as a triad of scarring alopecia of the scalp, nonscarring alopecia of the axillary and the pubic skin, and widespread lichenoid follicular papules.1 GLPLS more commonly affects women (male-to-female ratio ≃ 1:4), with the classic patient being a middle-aged Caucasian woman.2 While GLPLS is considered to be a manifestation of an immunologic disorder, predisposing factors are unclear and may be multifactorial. However immunosuppressive therapy confers limited and variable benefit, underscoring a longstanding need for therapeutic advances. The typical clinical course features progressive, scarring alopecia that may cause significant psychological distress to the patient.
CASE
A 58-year-old woman presented to the outpatient dermatology clinic with a tender and severely pruritic scalp skin eruption that began a few weeks before presentation. She described initially noticing welt-like lesions on her neck and face, along with a burning sensation in her scalp accompanied by hair loss. A dermoscopic exam revealed numerous peripilar casts and erythema on the scalp and hyperkeratotic erythematous follicular papules throughout the lumbosacral area, abdomen, and thighs (Figures 1, 2). Perifollicular erythema was seen on the axillae. A scalp punch biopsy revealed a perifollicular lichenoid lymphocytic infiltrate with fibrosis and a decreased number of terminal anagen hair follicles, some of which lacked sebaceous gland lobules. An abdominal punch biopsy revealed a perifollicular lymphocytic infiltrate with interface changes, hypergranulosis, and follicular plugging (Figure 3). A colloidal iron stain failed to reveal increased mucin deposition, and a PAS-D stain showed no evidence of basement membrane thickening or fungal infection. Overall, the clinical and histopathological findings were consistent with a diagnosis of GLPLS. The patient was instructed to apply topical clobetasol propionate 0.05% solution and minoxidil 5% solution twice daily on the scalp and augmented betamethasone dipropionate cream 0.05% BID on the body.
At a follow-up visit one month later, the patient reported resolution of her scalp pain and improvement of involved skin on the trunk and extremities. Tacrolimus ointment 0.1% for the scalp and the body twice daily on weekends and oral doxycycline 20 mg BID twice daily were added to the medication regimen, and topical corticosteroid treatments were restricted
At a follow-up visit one month later, the patient reported resolution of her scalp pain and improvement of involved skin on the trunk and extremities. Tacrolimus ointment 0.1% for the scalp and the body twice daily on weekends and oral doxycycline 20 mg BID twice daily were added to the medication regimen, and topical corticosteroid treatments were restricted
