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Follicular Lichen

Asian woman have problem with long hair loss attach in her hand.

Follicular Lichen Planopilaris (LPP) is an autoimmune disease that primarily affects women. It is located on the scalp and affects hair follicles by causing perifollicular inflammation. It can rarely occur in other areas of the body with hair growth.

It is also a common cause of scarring alopecia. The cause of its occurrence is unknown, and its main characteristic is intense hair loss, leading to the formation of bald areas in the hair.


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How does it manifest, and how is it diagnosed?

 The condition can affect the entire scalp, but it’s mainly located in the frontal region. In its early stages, it is accompanied by itching and hair loss, and later, scales and erythema can be observed around the follicles affected by the disease. The chronic inflammation that develops around the follicle causes the gradual, permanent loss of hair in the affected area. Within a span of months or years, the disease can clear a large portion of hair, leading to baldness.

Though this disease is more rare in men, in recent years, it has become more common, even affecting the beard area.

The diagnosis of follicular lichen planopilaris (LPP) is primarily the domain of the dermatologist, as it can often resemble other scalp skin conditions, such as lupus erythematosus. To rule out other diseases, a biopsy is recommended. The dermatologist collects a sample from the affected area using local anesthesia and then suggests appropriate treatment.

Diagnosis can often be difficult and may even elude experienced dermatologists. Therefore, a careful clinical examination and correct biopsy sampling are necessary. Failed hair transplant procedures are frequently due to the failure to diagnose lichen planopilaris before the operation, often because the hair transplant candidate wasn’t examined by an experienced dermatologist.
Περιπτώσεις αποτυχημένων επεμβάσεων μεταμόσχευσης μαλλιών οφείλονται σε μεγάλο βαθμό στην μη έγκαιρη διάγνωση του λειχήνα πριν την επέμβαση, επειδή δεν εξετάστηκε ο υποψήφιος για μεταμόσχευση μαλλιών από έμπειρο δερματολόγο.

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    Forms of Follicular Lichen Planopilaris (LPP)

    Frontal Fibrosing Alopecia (FFA)

    In FFA, there is progressive recession of the frontal and temporal areas, as well as gradual loss of eyebrows.

    Lassueur-Graham-Little Syndrome

    Lassueur-Graham-Little syndrome is a combination of smooth lichen lesions with alopecia in the armpits and pubic area.

    How is follicular lichen planopilaris treated?

    The manifestation of the disease varies from person to person. Sometimes it is progressive and evolves rapidly, while other times it recedes gradually. Relapses are also quite common. Treatments aim to slow the progression of the disease and reduce symptoms.

    The treatment of the disease may include:

    • Corticosteroids (topical or oral use)
    • Intralesional cortisone injections
    • Cyclosporine
    • Methotrexate
    • Hydroxychloroquine
    • Adipose-derived stem cell therapy
    • Autologous platelet-rich plasma therapy from the patient’s blood

    Depending on the severity and extent of the problem, the appropriate treatment is recommended. However, follicular lichen planopilaris is a very serious condition since hair loss is permanent. This means it requires immediate treatment by an experienced dermatologist.

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    Can Hair Transplants Help?

     Hair transplants have advanced significantly in recent years, providing amazing and natural results in areas with thinning and hair loss. They are performed exclusively with local anesthesia and are completely painless. Recovery is rapid, and you can return to work as soon as the next day.

    At our clinic, Derma Hair Clinic, under the direction of Dr. Karalexis, we have over 20 years of experience with hair transplants, even with particularly challenging cases. Hair transplant for this specific condition requires considerable expertise on the part of the doctor because the disease is chronic, and the procedure should only be done when the condition has been in complete remission for a considerable amount of time. In addition, a follow-up period is required to monitor the progress of the procedure. As far as we know, we might be the only clinic in Greece that has completed hair transplants for lichen planopilaris after strict patient selection.

    Είπαν για εμάς

    Βασιλική Γούναρη
    Βασιλική Γούναρη
    Τον εμπιστεύομαι χρόνια!! Είναι ένας εξαιρετικός επιστήμονας με πραγματικό ενδιαφέρον και γνώση για τον ασθενή!!Τον συνιστώ ανεπιφύλακτα τόσο για ιατρικά όσο και τις αισθητικές υπηρεσίες που προσφέρει ο χώρος.
    Έφη Κουτρούμπα
    Έφη Κουτρούμπα
    Εξαιρετικός ιατρός, άριστα καταρτισμένος! Το ίδιο και όλο το προσωπικό! Πολλά μπράβο για όλη του την ομάδα!!
    Eirini Sal
    Eirini Sal
    Εξαιρετικός γιατρός, τον συστήνω ανεπιφύλακτα!!
    Ario Rakip
    Ario Rakip
    Excellent service
    Αδαμαντια Παναγιωτα Φλαμπουρη
    Αδαμαντια Παναγιωτα Φλαμπουρη
    Έκανα αφαίρεση σπιλων με τον γιατρό και έμεινα απόλυτα ικανοποιημένη και από την διαδικασία αλλά και από την μετέπειτα παρακολούθηση μέχρι την αποθεραπεία !!!! Ευχαριστώ πολύ ❤️
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     The majority of cases occur in the age group of 45 to 60 years and mainly affect women, especially after menopause. However, the number of cases in men has been steadily increasing over time.

    The treatment of follicular lichen planopilaris typically involves a multi-faceted approach aimed at reducing inflammation and slowing disease progression. Here are some common treatments:

    • Corticosteroids: These are used to reduce inflammation, either topically or orally. Intralesional injections can also be effective.
    • Immunosuppressants: Medications like cyclosporine and methotrexate are sometimes used to suppress the immune system’s response.
    • Hydroxychloroquine: This anti-malarial medication has anti-inflammatory properties and is often used in autoimmune conditions.
    • Stemming Agents: Platelet-rich plasma (PRP) therapy and adipose-derived stem cell therapy are emerging as potential treatments.
    • Topical Treatments: Other topical agents such as tacrolimus and pimecrolimus may be used to manage inflammation.

    A key consideration is that follicular lichen planopilaris is a chronic condition. Thus, consistent monitoring and tailored treatment plans are essential. Given the irreversible nature of hair loss due to scarring, early diagnosis and treatment by a specialist are crucial to manage symptoms and prevent further hair loss.

    Finally, before considering more intensive interventions, a thorough diagnosis and discussion with a dermatologist with experience in autoimmune conditions affecting hair growth are essential. Hair transplantation, while potentially beneficial, should only be considered once the disease has been stable and in remission for a significant period.

     The cause of the disease is unknown. Recently, some have suggested that sunscreen creams applied to the facial area, particularly the forehead, might be implicated. However, this has not been proven.

     Under no circumstances can it be transmitted to other people.

     If a patient notices thinning at any point on the scalp, especially along the hairline, they should consult a specialist dermatologist. Hairdressers can also be invaluable in alerting us if something seems off with our hair. If you or someone you know experiences unusual hair thinning or loss, particularly with symptoms like itching, redness, or scales around the follicles, it’s advisable to seek professional evaluation.

    Follicular lichen planopilaris is an autoimmune disease and, once it appears in a person, it usually has a chronic course requiring regular monitoring by a specialized dermatologist. The aim of the treatment is to reduce the intense inflammation caused by the disease so that healthy hair follicles are not destroyed. This process requires time and patience.
    To consider a hair transplant in areas where there is thinning, the disease must be in complete remission. This needs to be carefully evaluated by a specialized dermatologist after a long period of monitoring the patient, as there’s always a risk of the disease flaring up again. Therefore, the treatment plan may vary from patient to patient, and frequent follow-ups are necessary to ensure the condition remains under control and doesn’t relapse.

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