INTRODUCTION
Lichen planopilaris (LPP) is a cicatricial alopecia that presents with patchy or diffuse hair loss at the vertex or parietal scalp. Although there is no gold standard therapy, most interventions are immune modulating and aimed at reducing inflammation and terminating the scarring process to prevent further fibrosis.3 Even amongst patients who respond to therapy, hair loss at alopecic sites is generally considered permanent due to the condition's destruction of multipotent follicular stem cells.2,4 Here we present a case of reversible hair loss in a patient treated with topical, intralesional, and systemic therapy.
CASE REPORT
A 46-year-old Caucasian woman with a history of hypothyroidism, well controlled on Synthroid 100 mcg daily, presented to our clinic with significant hair shedding and scalp flaking occurring over the previous 10 months. She did not report any associated scalp pain, pruritus nor mucosal lesions.
On physical examination, the patient was found to have a small alopecic patch with surrounding scale at the central vertex of the scalp. Trichoscopy revealed perifollicular erythema and hyperkeratosis. A 4-mm punch biopsy was performed at the involved site. Histopathologic examination demonstrated follicular dropout characterized by fibrous tracts, diminished number of sebaceous glands, and polytrichia. Sparse lymphocytic inflammation with subtle interface changes within the zones of fibrosis was also noted (Figure 1). A pathologic diagnosis of lichen planopilaris (LPP) was made, confirming clinical suspicion.
On physical examination, the patient was found to have a small alopecic patch with surrounding scale at the central vertex of the scalp. Trichoscopy revealed perifollicular erythema and hyperkeratosis. A 4-mm punch biopsy was performed at the involved site. Histopathologic examination demonstrated follicular dropout characterized by fibrous tracts, diminished number of sebaceous glands, and polytrichia. Sparse lymphocytic inflammation with subtle interface changes within the zones of fibrosis was also noted (Figure 1). A pathologic diagnosis of lichen planopilaris (LPP) was made, confirming clinical suspicion.
