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Red scalp is a common complaint that may constitute a diagnostic and therapeutic challenge in daily clinical practice. Among the numerous diseases to cause diffuse scalp erythema are psoriasis, seborrhoeic dermatitis, contact dermatitis, diffuse lichen planopilaris, dermatomyositis and scalp rosacea. Accurate diagnosis is crucial for optimal treatment outcomes. Histology most frequently discriminates the underlying condition, but it requires scalp biopsy. In many cases, the combination of clinical examination and trichoscopy is sufficient for establishing the correct diagnosis. The main trichoscopic features of psoriasis are silver-white scaling, regularly distributed dotted (glomerular) vessels or twisted red loops, and punctate haemorrhages. Yellowish-white scaling and thin arborizing vessels are typical features of seborrhoeic dermatitis. Contact dermatitis is characterized by the presence of yellow exudate and polymorphic vessels, while perifollicular scaling and erythema with the lack of follicular openings are typical findings in lichen planopilaris. In scalp dermatomyositis, tortuous and arborizing vessels with interfollicular and perifollicular pigmentation may be detected. The most characteristic features of scalp rosacea are perifollicular scaling and polygonal/arborizing vessels. This review also summarizes histological features and therapeutic options for these conditions., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Lichen planopilaris and frontal fibrosing alopecia are primary scarring alopecias where diagnosis can be suggested by clinical and trichoscopy features, especially in the early stages, but scalp biopsy is the standard exam for definitive diagnosis. Frontal fibrosing alopecia is considered a variant of lichen planopilaris, as the histopathological findings are similar, with a perifollicular lymphohistiocytic infiltrate, sometimes with a lichenoid pattern. A thorough clinical examination, trichoscopy and photographic documentation are essential to assess the evolution and therapeutic response. To date, there are no validated treatments or guidelines for these diseases, but there are recommendations that vary with the individual characteristics of each patient. This article presents a comprehensive review of the literature, including an update on topics related to the diagnosis, follow-up, histopathological aspects and available treatments for lichen planopilaris and frontal fibrosing alopecia, highlighting their similarities, differences and peculiarities., (Copyright © 2022 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Lichen planopilaris is a primary lymphocytic cicatricial alopecia that commonly presents with hair loss at the vertex or parietal scalp. Patients may also have associated scalp itching, burning or tenderness. Due to scarring, hair loss is typically permanent. The main goals of treatment are reducing symptoms and preventing disease progression and further hair loss. Currently, the literature has limited evidence on treatments for this difficult condition, and most available evidence is from case reports and case series. Furthermore, the evidence shows a varied response to therapy, with frequent reports of poor response. This article reviews the diagnosis of this rare disease, summarize the currently available treatments, and provide insights and practices from alopecia experts., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Lichen planopilaris is an uncommon dermatological manifestation of lichen planus of the scalp and results in cicatricial alopecia. We present a patient with lichen planopilaris and significant post-inflammatory pigmentary alteration, confirmed by histopathology. The patient's case represents a clinically important variation from an expected typical pattern of dyschromia at periphery of alopecic zones in lichen planopilaris.

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are lymphocytic scarring alopecias affecting primarily the scalp. Although both diseases may share some clinical and histopathological features, in the last decade, FFA has become an "epidemic" particularly in Europe, North and South America with unique clinical manifestations compared to LPP, thus, raising the idea that this disease may have a different pathogenesis. Symptoms such as scalp burning, pruritus or pain are usually present in both diseases, suggesting a possible role for nerves and neuropeptides in the pathogenesis of both diseases. Based on some previous studies, neuropeptides, such as substance P (SP) and calcitonin gene-related peptide (CGRP), have been associated with lipid metabolism and many chronic inflammatory disorders. In this study, we asked if these neuropeptides are associated with LPP and FFA scalp lesions. Alteration in the expression of SP and CGRP in affected and unaffected scalp skin from patients with both diseases was found with examination of sections using immunohistochemical techniques and confocal microscopy. We then quantitatively assessed and compared SP and CGRP expression from control, LPP and FFA scalp biopsies. Although LPP and FFA share similar histopathologic findings, opposite results were found in affected and unaffected scalp in the ELISA tests, suggesting that these diseases may have different pathogenic mechanisms. We also found presence of histopathological inflammation irrespective of evident clinical lesions, which raises the possibility that both diseases may be more generalized processes affecting the scalp., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Dermoscopy can be helpful in assessing nonpigmented lesions and inflammatory processes like lichen planopilaris (LPP)., Material & Methods: In this observational prospective study, 81 patients with a cicatricial alopecic patch on their scalp were included and underwent dermatologic examination. A biopsy was taken from the active part of the lesion based on dermoscopy evaluation., Results: Analysis of 44 patients with definite diagnosis of LPP revealed that the mean age at the time of presentation was 44.05 ± 12.62 years. More than 77% of patients had at least one form of the follicular opening disorder. About 75% of patients had shaft disorders. The most common pattern of pigmentation was milky-red (97.73%). The irregular and ectatic vascular network were seen in 59.09% of patients. Patients with coiled and twisted hairs, small yellow dots, large yellow dots, and peripilar sign were more likely to have shorter disease duration (P < 0.05). Those with overall shaft disorders were younger (P = 0.02). Small yellow dots (P = 0.025) and peripilar sign (P = 0.039) were more common in female patients., Conclusion: Dermoscopy can be a helpful diagnostic tool in differentiating LPP among patients with primary cicatricial alopecia (PCA). Larger cohort studies are recommended to find the role of demographic factors in predicting the dermoscopic patterns among LPP patients., (© 2019 The International Society of Dermatology.)

Lichen planus (LP) is an idiopathic inflammatory disease of the skin, hair, nails, and mucous membranes. Classic cutaneous LP is characterized by violaceous flat-topped papules that typically favor the extremities. LP on the scalp, otherwise known as lichen planopilaris, classically presents with scarring alopecia, perifollicular erythema and follicular prominence. Although LP pigmentosus presents primarily as hyperpigmentation, there is only one previous report of hypopigmented LP. In this report, the authors report 2 cases of LP that presented primarily as hypopigmented macules in 2 African American men. The first patient presented with hypopigmented macules on face and scalp as well as trunk and extremities. The second patient presented with hypopigmented macules on scalp with associated alopecia. Histopathological examination from both patients showed features of LP. The authors propose a new variant of LP that presents acutely as hypopigmented lesions.

Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus of unclear etiology that predominantly affects patients of skin types III to VI. We report a case of LPP of two years duration in a 67-year-old man involving upper extremities, chest, abdomen, and upper back.

Lichen planus follicularis tumidus (LPFT) is a rare subtype of lichen planus (LP) that has been most commonly described in middle-aged women. LPFT clinically manifests as recurrent cystic follicular nodules that preferentially involve the retroauricular area; concurrent classic LP lesions on the extremities and mucosal surfaces may also be present. Histologically, LPFT demonstrates epithelial-lined follicular cysts filled with orthokeratotic keratin surrounded by a dense lichenoid infiltrate. We present a case of a 67-year-old man with clinical and histopathologic findings consistent with LPFT and discuss differential diagnostic considerations for entities resembling LPFT. Lastly, treatment options for LPFT are reviewed.

Background: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) represent 2 entities that cause primary cicatricial alopecia. These entities are clinically different; nevertheless, the literature suggests that FFA represents a form of LPP. The main argument in support of this hypothesis is that previous studies comparing the histologic findings have not found obvious differences between these diseases., Methods: Our objective was to more critically compare and contrast 20 histologic findings of these diseases in a large number of patients in order to determine any significant histologic differences between LPP and FFA., Results: We found 3 parameters that were statistically different, namely the presence of terminal catagen-telogen hairs (50% FFA vs 23.5% LPP; P = .020); a severe perifollicular inflammatory infiltrate (29.4% LPP vs 4.6% FFA; P = .010) and a zone of concentric lamellar fibroplasia (85.3% LPP vs 63.6% FFA; P = .041)., Conclusions: Although a few histologic features differ between FFA and LPP, we believe that these differences are too subtle or non-specific to distinguish between them with confidence. Therefore, clinical correlation is essential to establish the diagnosis., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Lichen planopilaris (LPP) is a variant of lichen planus that affects the scalp causing scarring hair loss. Patients also frequently experience symptoms of scalp itch, pain, and burning. To date, there are no long-term remittive nor curative therapies available. Low-dose naltrexone has anti-inflammatory properties and has recently been described in the context of treating autoimmune conditions. This retrospective medical record review describes four LPP patients treated with low-dose (3 milligrams per day) naltrexone. This medication provided benefit in these four patients including reduction in symptoms of pruritus, clinical evidence of inflammation of the scalp, and disease progression. All patients tolerated naltrexone without adverse effects. This is the first case series demonstrating the beneficial effects of low-dose naltrexone for patients with LPP. This medication was well-tolerated by the patients and is cost-effective.

J Drugs Dermatol. 2017;16(11):1140-1142.

Lichen planus is an inflammatory skin conditionwith characteristic histopathological findings thathas many clinical variants. Recently, there have been25 cases reported in the literature of lichen planuspigmentosus (LPPi) that preceded the developmentof frontal fibrosing alopecia (FFA), which is a variantof lichen planopilaris (LPP). We review the literatureregarding LPPi, LPP, and FFA and present a case of a40-year-old African American woman with LPPi andLPP.

Cytokeratins are a major component of colloid bodies that are essentially diagnostic of lichen planopilaris (LPP). Here, the authors assess the ability of the cytokeratin 903 antibody (CK-903) to stain colloid bodies and differentiate LPP from other histologically similar appearing primary cicatricial alopecias. A retrospective review of all specimens submitted to the dermatopathology department over a 2-year window identified 18 cases of LPP and 20 cases of histologically similar appearing entities (discoid lupus erythematosus or central centrifugal cicatricial alopecia) through a combination of H&E, elastic van gieson, and periodic acid-schiff stains. All 38 samples were then prospectively stained with CK-903. Colloid bodies were identifiable in 3 of the 18 LPP cases based on H&E alone but were seen in 9 of 18 cases when CK-903 was used. There were no cases where colloid bodies were seen on H&E but not subsequently identified with CK-903. Additionally, there was no CK-903 staining in any of the 20 cases of similar appearing entities except 1 case of discoid lupus erythematosus, which is known to occasionally show colloid bodies. The authors conclude that CK-903 is a useful adjunctive tool that will allow for a quicker, less costly, and more accurate diagnosis of LPP given its ability identify colloid bodies even in the setting of significant inflammation and fibrosis and its advantages over direct immunofluorescence of low cost, short preparation time, and lack of need for a specialized fluorescent microscope.

A case of localized lichen planopilaris over the face, extending to the scalp is presented.This case highlights the different variations, which can occur in the presentation of localized lichen planus. The case was unique because of the extension of the lesions into the scalp. We also wanted to demonstrate the peculiar dermoscopic patterns of active lichen planopilaris when occurring over the face.

Background: Differentiating lymphocytic scarring alopecias may be difficult clinically as well as histopathologically., Objective: To investigate plasmacytoid dendritic cell (PDC) presence and distribution patterns and their diagnostic value in differentiating scarring alopecias of lupus erythematosus (LE) from lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA)., Methods: Seventeen LE-associated alopecia, 20 LPP and 10 FFA cases were immunohistochemically tested for PDC presence/distribution and activity., Results: LE-associated alopecia showed increased PDC content (≥10% PDCs in all cases and ≥50% in 94% of cases), PDC clusters (100% of cases), and deeper dermal and perieccrine distribution (100% of cases) with involvement of the dermoepidermal junction (DEJ, 94% of cases), while the majority of LPP and FFA had <10% PDC content that was mainly confined to the upper dermis surrounding the hair infundibulum with rare DEJ involvement and rare clustering., Conclusions: Specific PDC-related parameters may serve as a useful diagnostic adjunct in the differentiation between LE-associated alopecia versus LPP and FFA.

Lichen planopilaris (LPP) is considered to be a follicular variant of lichen planus. Clinical variants include classic LPP, frontal fibrosing alopecia, and the Graham-Little-Piccardi-Lassueur syndrome. The pathogenesis of LPP remains to be fully elucidated, but like other cicatricial alopecias involves the irreversible destruction of hair follicle stem cells and loss of a hair follicle's capacity to regenerate itself In the early stages of LPP, patients may have scalp pruritus, burning, tenderness, and increased hair shedding. A scalp biopsy shows a lymphocytic infiltrate involving the isthmus and infundibulum. Apoptotic cells present in the external root sheath and concentric fibrosis surrounds the hair follicle. Treatment is prescribed with the goal to alleviate patient symptoms and to halt the progression of hair loss. Treatment involves use of potent topical corticosteroids and/or intralesional corticosteroids. Options for systemic treatment include anti-inflammatory agents such as hydroxychloroquine, tetracyclines, pioglitazones, and immunosuppressive medications such as cyclosporine, mycophenolate mofetil, or systemic corticosteroids. Hair transplantation may also be an option if the disease has been in clinical remission. The management of LPP can sometimes be challenging and additional research is needed to improve outcomes for patients.

Background: Lichen planopilaris (LPP) is a type of primary scarring alopecia. The pathogenesis is poorly understood, although traumatic skin injury has been implicated in some cases., Objective: To present 17 patients diagnosed with LPP after hair transplant surgery., Materials and Methods: A retrospective review of the records of patients referred for evaluation of suboptimal growth after hair transplantation and diagnosed with LPP. Patients' scalps were evaluated using dermoscopy, and scalp biopsies were performed in all patients to confirm the diagnosis of LPP., Discussion: Seventeen patients (15 male, 2 female) were diagnosed with LPP after hair transplant surgery. The timing of disease occurrence was variable--4 to 36 months after hair transplantation. The most common symptom was itching. Perifollicular erythema or perifollicular scale, the classical dermatoscopic signs of LPP,was present in 12 patients (70%)., Conclusion: These data provide further support for an association between hair transplant surgery and the development of LPP. Traumatic skin injury from recipient site creation may be relevant to the pathogenesis. The incidence of this phenomenon and risk factors remain to be clarified.

Androgenetic alopecia is often treated by follicular unit transplantation, a technique that involves minimal risk of hair loss because of the more resistant nature of the donor area. Lichen planopilaris is a cicatricial alopecia that causes permanent destruction of hair follicles. We report two cases of post-transplantation lesions compatible with lichen planopilaris in both recipient and donor areas. The quality of the hair follicles in the donor area was apparently compromised by lichen planopilaris, the probable cause of hair loss. Similar reports are rare. When lichen planopilaris is suspected, a biopsy of the scalp must be performed to avoid transplantation during disease activity.

Primary cicatricial alopecias (PCAs), rare disorders that lead to permanent hair loss, have been poorly understood and are difficult to treat. Lichen planopilaris (LPP)is a prototypical PCA; patients often present with sudden onset of hair loss and clinically significant symptoms of itching, burning, and pain of the scalp. Examination reveals patchy alopecia or a more diffuse thinning of the scalp with characteristic perifollicular erythema and perifollicular scale at the margins of the areas of alopecia.Treatment typically includes use of antiinflammatory medications; although symptoms may improve,hair loss is often progressive.

Lichen planopilaris (LPP), a follicular form of lichen planus, is a rare inflammatory lymphocyte mediated disorder. Although the physiopathology is unclear, an autoimmune etiology is generally accepted. Women are affected more than men, and the typical age of onset is between 40 and 60 years. LLP is a primary cicatricial alopecia whose diagnosis is supported in the early stage by both clinical and histopathological findings. Within the margins of the expanding areas of perifollicular violaceous erythema and acuminate keratotic plugs, the histology can show the lichenoid perifollicular inflammation. LPP can be subdivided into 3 variants: classic LPP, frontal fibrosing alopecia (FFA), and Lassueur Graham-Little Piccardi syndrome. With the exception of FFA, the hairless patches of the scalp can be unique or can occur in multiples and can present with a reticular pattern or as large areas of scarring. This condition can have major psychological consequences for the affected patients. The therapeutic management often is quite challenging, as relapses are common after local or systemic treatments. Further research is needed on the pathogenesis, and randomized controlled trials of treatment with scientific evaluation of the results are necessary to appreciate the proposed treatment.

To describe a case of bilateral cicatrizing keratoconjunctivitis in a patient with lichen planus and review the literature. Conjunctiva cicatrization with symblepharon formation, dry eye, corneal infiltration and neovascularization and thinning were the most observed prominent signs. Diagnosis was based on clinical findings and biopsy, after exclusion of typical causes of cicatricial keratoconjunctivitis.

A 34-year-old woman presented with large, scaly patches of alopecia with a peripheral rim of violaceous, folliculocentric papules and appreciable pruritus of one-year duration. Histopathologic examination showed changes consistent with lichen planopilaris and psoriasis, which was suggested by neutrophilic spongiosis. Consequently, cyclosporine and betamethasone valerate topical 0.12 percent foam twice daily were initiated. A short time after, there was clinical reduction of perifollicular erythema and attenuation of pruritus. However, there was no decrease of scale. Although LLP is classified in the lymphocytic group of cicatricial alopecias, this case demonstrates a clinical and histopathologic overlap with a psoriasiform dermatosis which may represent a collision of two diseases.

Background: Lichen planopilaris (LPP) is a potential trichologic emergency that can result in permanent scarring alopecia. Histopathology is a key component of the diagnostic work-up., Objective: To identify the key histologic features that characterize LPP in order to facilitate diagnosis, ultimately leading to improved patient outcomes., Methods: Scalp biopsy specimens from 27 confirmed cases of LPP were reviewed in a blinded fashion to determine diagnostically helpful histologic features., Results: Absence of arrector pili muscles and sebaceous glands, a perivascular and perifollicular lymphocytic infiltrate in the reticular dermis and mucinous perifollicular fibroplasia within the upper dermis with absence of interfollicular mucin, and superficial perifollicular wedge-shaped scarring were characterizing features., Limitations: Sample size was limited, given that biopsy specimens were taken from lesions at varying stages of evolution and findings vary with disease stage., Conclusions: This study confirms many previously reported histologic features and highlights new characterizing features of mucinous perifollicular fibroplasia.

Lassueur-Graham-Little-Piccardi syndrome (LGLPS) is a rare lichenoid dermatosis characterized by progressive cicatricial alopecia of the scalp, loss of pubic and axillary hairs and keratosis pilaris. The syndrome is considered a form of follicular lichen planus (LP). Although the familial occurrence of LP is a well-described phenomenon, no familial case of LGLPS has ever been reported. We describe the occurrence of LGLPS in a mother and her daughter. HLA typing revealed HLA-DR1 in both patients. Topical tacrolimus was of partial benefit in the daughter., (Copyright 2004 S. Karger AG, Basel)

Two cases of frontal fibrosing alopecia in post menopausal women, one of them biopsy-proven, are reported. Both women showed a progressive marginal alopecia and none had multifocal areas of involvement typical of lichen planopilaris nor the mucosal or cutaneous lesions of lichen planus. However, scalp biopsy specimens from the frontal hair margin showed perifollicular fibrosis and lymphocytic inflammation. Because the histologic findings are indistinguishable from those seen in lichen planopilaris, frontal fibrosing alopecia is considered a variant of lichen planus pilaris with a particular specific localization and usually onset in the postmenopausal age.

P, a 20-year-old laborer displayed initial symptoms of the disease in question when he was 10 years old. Initially he had an asymptomatic progressive loss of hair on the scalp. A couple of years later he had mild to moderate pruritus, and the appearance of slate-blue eruptions on the scalp and elsewhere on the body. This resulted in a complete loss of hair on the vault of the scalp, which led him to seek specialist opinion. Skin surface examination revealed the presence of grayish-blue acuminate follicular papules, disposed singly and in groups (plaques). The pilo-sebaceous orifices were conspicuously obliterated and filled by keratin plugs. Perifollicular erythema was a predominant feature on the scalp. The lesions were present over the scalp, around the neck, chest, back, axillae, groin and legs. Shiny atrophied scalp skin depicting scarring alopecia mimicking male-type baldness was a salient feature. In addition, it was studded with conspicuous acuminate papules in its center (Fig. 1a). The known nonhairy (glabrous) skin had classic lichen planus lesions (Fig. 1b). Hemotoxylin-eosin stained microsections prepared from typical lichen planus (LP) lesions over the abdomen and those of lichen planopilaris (LPP) of the scalp were simultaneously studied. The former revealed changes in the epidermis comprising of hyperkeratosis, increase in thickness of stratum granulosum, hydropic degeneration of the basal cell layer and band-like lympho-histiocytic infiltrate pressing against and invading the epidermis, while the latter revealed uniform atrophy of the epidermis and vacuolization of basal cells. The hair follicles were dilated and were filled with keratin plugs. In addition to fibrosis of the dermis, pigment laden microphages and lympho-histiocytic infiltrate was prominent. The follicles and the sebaceous glands were absent. However, arrectores pilorum and sweat glands were preserved (Fig. 2a,b).

Background: Androgenetic alopecia is characterized by a defined area of progressive nonscarring alopecia. The clinical and histological findings in 15 women and 4 men with progressive scarring alopecia in a pattern distribution were studied. The results were evaluated and compared with clinicopathologic entities that feature scarring of the central scalp area, specifically, lichen planopilaris, pseudopelade, and follicular degeneration syndrome., Observations: Patients developed progressive fibrosing alopecia of the central scalp, without the multifocal areas of involvement typical of lichen planopilaris and pseudopelade. Perifollicular erythema, follicular keratosis, and loss of follicular orifices were limited to a patterned area of involvement. Biopsy specimens of early lesions demonstrated hair follicle miniaturization and a lichenoid inflammatory infiltrate targeting the upper follicle region. Advanced lesions showed perifollicular lamellar fibrosis and completely fibrosed follicular tracts indistinguishable from end-stage lichen planopilaris, pseudopelade, or follicular degeneration syndrome., Conclusions: Some patients with androgenetic alopecia might have additional clinical and histological features of inflammation and fibrosis limited to the area of androgenetic hair loss. In these patients, the histological findings of early lesions are identical to those seen in lichen planopilaris. The lichenoid tissue reaction leading to follicular destruction in these patients might be pathogenetically related to the events underlying androgenetic alopecia.

Background: Lichen planopilaris usually produces multifocal areas of scarring alopecia. Recently, a condition in postmenopausal women characterized by progressive frontal hairline recession associated with scarring has been described., Objective: Our purpose was to study the clinical and histopathologic features and results of treatment in a group of women with the frontal variant of lichen planopilaris and to compare the immunohistochemical profile of scalp biopsy specimens from this subset with that found in the multifocal variant of lichen planopilaris., Method: The clinical data as well as the histopathologic findings in 16 women with frontal fibrosing alopecia were collated. The immunohistochemical profile of six scalp biopsy specimens from the frontal hairline were compared with six specimens from women with multifocal lichen planopilaris., Results: In addition to the progressive frontal fibrosing alopecia in all 16 women, total loss or a marked decrease of the eyebrows was observed in 13. No evidence of lichen planus was observed at other sites. In one patient multifocal areas of lichen planopilaris developed in the scalp. The frontal fibrosing alopecia was slowly progressive but has stabilized in five patients. Biopsy specimens from the frontal hairline showed histologic changes identical to lichen planopilaris. Immunophenotyping failed to reveal any significant differences between the frontal and multifocal variants. No effective treatments emerged although oral steroids and antimalarials may temporarily slow the course. Hormone replacement therapy did not appear to influence the course of the alopecia., Conclusion: Progressive frontal fibrosing alopecia is a clinically distinct variant of lichen planopilaris that affects in particular elderly women and frequently involves the eyebrows. The basis for this lichenoid tissue reaction targeting frontal scalp follicles and eyebrows is unknown.

Background: We report an exceptional clinical presentation of erosive lichen planus of the scalp associated with hepatitis C and idiopathic CD4 lymphocytopenia., Case Report: A 90-year-old woman was hospitalized in May 1995 for erosive dermatosis of the scalp and alopecia, associated with ungual lesions. Histology of the scalp lesions demonstrated lichen and the serology tests were positive for hepatitis C. The patient also had severe CD4 lymphocytopenia (290/mm3). The lesions regressed with clobetasol and occlusion and growth of scalp hair turned., Discussion: Erosive lichen planus of the scalp has, to our knowledge, not been reported previously. The causal effect of drugs taken by this patient (tetrazepam and clorazepam) was not retained. Seropositivity for hepatitis C (with no evidence of active disease) was however probably not fortuitous. The association with CD4 lymphocytopenia merits discussion.

Four patients are presented with pseudopelade of Brocq whose symptoms also illustrate the spectrum of symptoms of lichen planus. The literature is reviewed and the clinical and histologic features of pseudopelade of Brocq and lichen planopilaris are described. The literature on pseudopelade of Brocq is confusing and outdated. Since Degos's article in 1954, it has become commonly accepted that pseudopelade of Brocq is a nonspecific cicatricial end stage of scalp diseases resulting in alopecia. We maintain instead that pseudopelade of Brocq and lichen planopilaris are basically the same condition, namely a manifestation of lichen planus.

Background: We review the findings in a large series of patients with lichen planopilaris., Objective: Clinical, histologic, and direct immunofluorescence findings were reviewed in 45 patients., Methods: Scalp biopsy specimens for routine histologic examination and direct immunofluorescence were reviewed. Clinical data and follow-up were obtained., Results: Women were affected more commonly and had patchy hair loss, with perifollicular erythema, perifollicular spines, and scarring. Half had or developed glabrous skin, mucous membrane, or nail changes typical of lichen planus. Follicular involvement was limited to the infundibulum and isthmus and included lichenoid inflammation and cytoid formation, with few or no changes in interfollicular epidermis. Direct immunofluorescence showed cytoid body staining with anti-IgM and anti-IgA and patchy or linear fibrinogen deposition along the basement membrane zone. The various therapeutic options used were usually unsuccessful., Conclusion: To make the correct diagnosis, patients with scarring alopecia should be evaluated histologically and with direct immunofluorescence. They should also be followed up to assess whether lichen planus develops elsewhere.

The lichen planus follicularis tumidus was described by Belaich et al. in 1977, and we have found 13 cases published so far. We report two cases we have recently seen, one of them with multiple lesions on the head, and the other with a temporo-frontal lesion.

Background: Lichen planopilaris is believed to be a variant of lichen planus because both diseases have similar histologic features. However, as the clinical features of the two diseases differ, we conducted immunofluorescence studies to examine the relation between the two conditions more closely., Observations: Direct immunofluorescence was performed on scalp lesions of seven patients with lichen planopilaris. All had abnormal linear deposits of Ig restricted to the basement membrane zone of hair follicles. The deposits consisted of only IgG or IgA in five patients (70%) and of IgG in combination with other Igs in two patients (30%). Basement membrane zone deposits of fibrin were present in only one patient (14%) and were linear in appearance. There was no staining of ovoid bodies. These immunofluorescence abnormalities differ from those associated with lichen planus where basement membrane zone deposits of fibrin are present in almost all patients, where the basement membrane zone deposits are fibrillar in appearance, and where the deposits of Ig over ovoid bodies are common., Conclusions: The different appearance and composition of abnormal deposits of immunoreactants in lichen planopilaris and lichen planus suggest that the two conditions are different diseases.