Lichen Planopilaris, Dijagnosis and Therapy Challenge - Case Report
International Journal of Clinical Dermatology
Volume 1, Issue 2, December 2018, Pages: 34-38
Received: Sep. 1, 2018; Accepted: Sep. 25, 2018; Published: Oct. 23, 2018
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Authors
Gordana Savčić, Department of Dermatovenerology, Health Center Kragujevac, Kragujevac, Serbia
Miloš Kostov, Department of Forensic Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
Mirjana Paravina, Department of Dermatovenerology, Faculty of Medicine, University of Niš, Niš, Serbia
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Abstract
Background: Lichen planopilaris is relatively rare inflammatory disorder that results in cicatricial alopecia. It is a rare, cutaneous form of lichen planus which affects hair follicles, most commonly on the scalp area. It is caused by an autoimmune disorder that leads to follicular destruction and permanent hair loss. Case history: We are presenting the case of a patient who is 21 years old and who suffers from cicatricial alopecia and follicular hyperkeratosis of the parietal region of the scalp. Initially, she was diagnosed with seborrheic dermatitis and has been treated with local corticosteroid therapy for several months by her doctor. She was admitted to the Department of Dermatology with lessions located on the scalp. A clinical examination revealed exudative erythema with prominent circumferential hair follicle openings and the presence of sticky, yellowish crusts and scales whose removal caused bleeding. There were a several locations with significant cicatricial alopecia which look like porcelain. Dermoscopy showed perifollicular squamas. Routine laboratory analyses and immunological analysis were in normal range. Finally, after taking a biopsy and histopathological findings, we have come to a differential diagnosis which may include fibrous and suppurativ follicular disorders, as well as lichen planopilaris. The patient was treated with keratolytic lotions, combination of corticosteroid preparation and salicylic acid applied topicaly, and tacrolimus 1% cream which was used twice per day for several months. This terapy was successful, crusts did not return and progression of the disease was stopped.
Keywords
Lichen Planopilaris, Alopecia Cicatricialis, Inflamation
To cite this article
Gordana Savčić, Miloš Kostov, Mirjana Paravina, Lichen Planopilaris, Dijagnosis and Therapy Challenge - Case Report, International Journal of Clinical Dermatology. Vol. 1, No. 2, 2018, pp. 34-38. doi: 10.11648/j.ijcd.20180102.12
Copyright
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Cooper S. Lichen planopilaris. Orphanet. March 2011; http://wwworpha.net/consor/cgibin/Disease Search.php?Ing=EN&data id=8580.
[2]
Olsen EA. Female pattern hair loss and its relationship to permanent/cicatricial alopecia: a new perspective. J Investig Dermatol Symp Proc. 2005 Dec. 10 (3):217-21. [Medline].
[3]
Matta M, Kibbi AG, Khattar J, Salman SM, Zaynoun ST. Lichen planopilaris: a clinicopathologic study. J Am Acad Dermatol. 1990 Apr. 22 (4):594-8. [Medline].
[4]
Lyakhovitsky A, Amichai B, Sizopoulou C, Barzilai A. A case series of 46 patients with lichen planopilaris: demographics, clinical evaluation, and treatment experience. J Dermatolog Treat. 2015; 26 (3):275–9. [PubMed].
[5]
Fertig RM, Hu S, Maddy AJ, et al. Medical comorbidities in patients with lichen planopilaris, a retrospective case-control study. [Published online ahead of print April 16, 2018]. Int J Dermatology. doi:10.1111/ijd.13996.
[6]
Assouly P, Reigagne P. Lichen planopilaris: update on diagnosis and treatment. Semin Cutan Med Surg. 2009; 28 (1):3–10. [PubMed].
[7]
Errichetti E, Figini M, Croatto M, Stinco G. Therapeutic management of classic lichen planopilaris: a systematic review. Clin. Cosmet Investig Dermatol. 2018; 11:91-102. Doi:10.2147/CCID. S137870.
[8]
Rácz E, Gho C, Moorman PW, Noordhoek Hegt V, Neumann HA. Treatment of frontal fibrosing alopecia and lichen planopilaris: a systematic review. J Eur Acad Dermatol Venereol. 2013; 27 (12):1461–70. [PubMed].
[9]
Errichetti E, Stinco G. Dermoscopy in general dermatology: a practical overview. Dermatol Ther (Heidelb) 2016; 6 (4):471–507. [PMC free article] [PubMed].
[10]
Wilk M, Zelger BG, Zelger B. Lichen Planopilaris-histologic Criteria & Clues in Vertical Sections. Hair Ther Transplant 2013; 3: 111. doi:10.4172/2167-0951.1000111.
[11]
Sperling LC, Cowper SE. The histopathology of primary cicatricial alopecia. Semin Cutan Med Surg 2006; 25: 41-50.
[12]
Sellheyer K, Bergfeld WF. Histopathologic evaluation of alopecias. Am J Dermatopathol. 2006; 28:236-59.
[13]
Chiang C, Sah D, Cho BK, Ochoa BE, Price VH. Hydroxychloroquine and lichen planopilaris: efficacy and introduction of Lichen Planopilaris Activity Index scoring system. J Am Acad Dermatol. 2010 Mar. 62 (3):387-92. [Medline].
[14]
Naeini FF, Saber M, Asilian A, Hosseini SM. Clinical efficacy and safety of metotrexate versus hydroxychloroquine in preventing lichen planopilaris progress: A randomized clinical trial. Int J Prev Med. 2017; 8:37.
[15]
Tian H, Cronstein BN. Understanding the mechanisms of action of methotrexate: Implications for the treatment of rheumatoid arthritis. Bull NYU Hosp Jt Dis 2007; 65:168-73.
[16]
Brown PM, Pratt AG, Isaacs JD. Mechanism of action of methotrexate in rheumatoid arthritis, and the search for biomarkers. Nat Rev Rheumatol. 2016; 12:731-42.
[17]
Karnik P, Tekeste Z, McCormick TS, et al. Hair follicle stem cell-specific PPAR-gamma deletion causes scarring alopecia. J Invest Dermatol. 2009; 129 (5):1243–1257. [PMC free article] [PubMed].
[18]
Mirmirani P, Karnik P. Lichen planopilaris treated with a peroxisome proliferator-activated receptor gamma agonist. Arch Dermatol. 2009 Dec. 145 (12):1363-6. [Medline].
[19]
Spencer LA, Hawryluk EB, English JC., 3rd Lichen planopilaris: retrospective study and stepwise therapeutic approach. Arch Dermatol. 2009; 145 (3):333–4. [PubMed].
[20]
Tursen U, Api H, Kaya T, Ikizoglu G. Treatment of lichen planopilaris with mycophenolate mofetil. Dermatol Online J. 2004 Jul 15; 10 (1):24.
[21]
Spano F, Donovan JC. Efficacy of oral retinoids in treatment-resistant lichen planopilaris. J Am Acad Dermatol. 2014; 71:1016-8.
[22]
Donovan J, Samrao A, Ruben B, and Price V. Eyebrow regrowth in patients with frontal fibrosing alopecia treated with intralesional triamcinolone acetonide. British Journal of Dermatology. 2010; 163: 1142-4. doi:10.1111/j.1365-2133.2010.09994.x.
[23]
Blazek C, Megahed M. Lichen planopilaris. Successful treatment with tacrolimus. Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete. 2008; 59: 874-7. 10.1007/s00105-008-1650-8.
[24]
Al-Maweri SA, Kalakonda B, Al-Soneidar WA, Al-Shamiri HM, Alakhali MS, and Alaizari N. Efficacy of low-level laser therapy in management of symptomatic oral lichen planus: a systematic review. Lasers Med Sci. 2017; 32: 1429–37.
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