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Lichen planopilaris (LPP) is a cicatricial (scarring) alopecia, which presents with patchy or diffuse hair loss. It predominantly affects women aged 30-60 and can be categorized into 3 variants: classic lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and Graham-Little-Piccardi-Lasseuer syndrome (GLPLS).1,2 Although there are several treatment options, there is no gold standard therapy. Because LPP is believed to be mediated by lymphocytic infiltration, most therapies are immunomodulating. The goal of treatment is to mitigate symptoms, reduce inflammation, and terminate the cicatrizing. Therapeutic intervention should be based on clinicopathologic diagnosis, patient age, comorbidities, and clinical severity, which is defined by degree of inflammation, rapidity of disease progression, and extent of scalp involvement. As first-line therapy in patients with <10% scalp involvement, the authors typically initiate IL-TAC and TCM. For patients with >10% scalp involvement, the authors use these same therapies in addition to HCQ, doxycycline, and dutasteride. Patients recalcitrant to first-line therapies may add an additional anti-inflammatory agent (low-dose naltrexone, pioglitazone, methotrexate, mycophenolate mofetil, isotretinoin, cyclosporine) or excimer laser therapy depending on tolerability of potential adverse effects. Patients who initially present with rapidly progressive disease can be started on oral prednisone. See Table 80-1.
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