Diffuse variants of scalp lichen planopilaris: Clinical, trichoscopic, and histopathologic features of 40 patients

Michela Starace, Gloria Orlando, Aurora Alessandrini, Carlotta Baraldi, Francesca Bruni, Bianca Maria Piraccini
Journal of the American Academy of Dermatology 2020, 83 (6): 1659-1667

BACKGROUND: Fibrosing alopecia in a pattern distribution and cicatricial pattern hair loss are poorly recognized diffuse variants of lichen planopilaris (LPP).

OBJECTIVES: The medical features of 40 patients affected by a diffuse hair thinning associated with a long-lasting history of pruritus and erythema of the scalp and a histopathologic diagnosis of LPP were reviewed.

METHODS: Clinical data, results of trichoscopy and histopathology, response to treatment, and follow-up were analyzed.

RESULTS: There were 18 patients diagnosed with fibrosing alopecia in pattern distribution and 2 patients with cicatricial pattern hair loss. A new variant of diffuse LPP, named "lichen planopilaris diffuse pattern," was described in 20 individuals.

LIMITATIONS: Low number of cases due to rarity of the diseases.

CONCLUSION: In patients complaining of a long-lasting history of scalp erythema, itching/dysesthesia, and diffuse hair thinning, it is advisable to consider diffuse variants of LPP.

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