A New Subtype of Lichen Planopilaris Affecting Vellus Hairs and Clinically Mimicking Androgenetic Alopecia

Abbasi, Ali; Kamyab‐Hesari, Kambiz; Rabbani, Ramin; Mollaee, Farzaneh; Abbasi, Sheida

doi:10.1097/dss.0000000000000865

Cited by 13 publications

(18 citation statements)

References 29 publications

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“…In both subtypes, female patients were more frequently affected than men 29‐31 . Histologically LPP that mimics AGA has lichenoid inflammation and perifollicular fibrosis primarily affecting vellus hairs, 29 while FAPD shows identical findings to LPP and associated hair follicle miniaturization as seen in AGA 30,31 . In our study, one of the five patients with AGA had increased vellus hairs on histology.…”

Section: Discussionsupporting

confidence: 48%

“…This is unsurprising, as AGA is so common in males 28 . LPP affecting vellus hairs with clinical appearance of AGA and fibrosing alopecia in a pattern distribution (FAPD) have been described as subtypes of LPP 29,30 . In both subtypes, female patients were more frequently affected than men 29‐31 .…”

Section: Discussionmentioning

confidence: 99%

“…LPP affecting vellus hairs with clinical appearance of AGA and fibrosing alopecia in a pattern distribution (FAPD) have been described as subtypes of LPP 29,30 . In both subtypes, female patients were more frequently affected than men 29‐31 . Histologically LPP that mimics AGA has lichenoid inflammation and perifollicular fibrosis primarily affecting vellus hairs, 29 while FAPD shows identical findings to LPP and associated hair follicle miniaturization as seen in AGA 30,31 .…”

Section: Discussionmentioning

confidence: 99%

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Lichen planopilaris in men: a retrospective clinicopathologic study of 19 patients

et al. 2020

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Background Lichen planopilaris (LPP) is a scarring alopecia rarely described in men. Objective To investigate the clinical and histopathologic features of LPP in men. Methods We performed a retrospective cohort study of male patients with LPP seen at Mayo Clinic between 1992 and 2016. Results Nineteen men with biopsy‐confirmed LPP were included. The disease most commonly presented with diffuse (42.1%) or vertex scalp (42.1%) involvement. None of the patients had eyebrow or body hair involvement. Perifollicular erythema (94.7%) and pruritus (57.9%) were the most frequent clinical findings. Androgenetic alopecia (AGA) co‐occurred in 26.3% of patients. Mucosal lichen planus was found in four patients (21.1%). Thyroid disease occurred in three patients (15.8%). Disease improvement (47.3%) occurred with combination topical and systemic therapy, topical clobetasol monotherapy, and minocycline monotherapy. Conclusions LPP in men has similar clinical and histologic presentations as reported in women. Nonscalp hair loss appears less likely in men with classic LPP than reported in men with frontal fibrosing alopecia, while mucosal lichen planus and thyroid disease appear to be more common in classic LPP. Men with AGA can present with new‐onset concomitant LPP. Limitations included small study size, variable follow‐up, and lack of standardized clinical assessment due the study’s retrospective nature.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Lichen planopilaris in men: a retrospective clinicopathologic study of 19 patients

et al. 2020

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“…Loss of vellus or regrowing hair was the most common hair shaft disorder in patients which was consistent with the findings of Abbasi et al . who proposed that LPP may sometimes initially involve vellus hairs and may mimic androgenetic alopecia.…”

Section: Discussionsupporting

confidence: 90%

Dermoscopic features of lichen planopilaris in Northern Iran: a prospective observational study

et al. 2019

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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.

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“…Our study shows that FAPD predominantly affects Caucasian women (like FFA) and those with a family history of AGA, reflecting previous findings. 1,4,[13][14][15] However, this may in part be due to our patient demographics, with Europeans representing 68.5% of the Greater Melbourne population. Hair loss in all our patients was diffuse with no discernible bald patches.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics and treatment outcomes of fibrosing alopecia in a pattern distribution: A retrospective cohort study

Jerjen

Pinczewski

Sinclair

et al. 2021

Acad Dermatol Venereol

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Background Fibrosing alopecia in a pattern distribution (FAPD) is a primary cicatricial alopecia considered a subtype of lichen planopilaris (LPP). Objective The clinical and histopathological features, and treatment response of 24 female patients with FAPD were evaluated. Methods Demographic, clinical, histopathological and treatment data of patients with FAPD were retrospectively collected. Results Twenty‐four women were included (mean age 60.7 years). The mean Lichen Planopilaris Activity Index score was 1.50, and the median Sinclair grade was 3. Twelve patients had diffuse alopecia in the centroparietal region, four had frontal accentuation and eight had vertex accentuation of hair loss. Eight had associated loss of facial hair. Predominant trichoscopic features included hair shaft diameter variability (100%), perifollicular erythema and/or scaling (95%) and loss of follicular ostia (95%). Histopathological examination revealed features of scarring alopecia with interface changes in follicular epithelia mainly targeting terminal and intermediate hairs, and less frequently, vellus hairs. Treatment with hair growth‐promoting, anti‐inflammatory and anti‐androgen agents arrested disease progression in 14 patients and resulted in hair regrowth in two patients. Six patients had progression of their hair loss in spite of treatment. Limitations Referral bias to a specialist hair clinic, retrospective design and small sample size. Conclusions We present clinicopathological features of FAPD which can aid in the diagnosis of this insidious scarring alopecia. Our findings suggest a more favourable outcome if treatment is initiated in early stages of the disease.

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A New Subtype of Lichen Planopilaris Affecting Vellus Hairs and Clinically Mimicking Androgenetic Alopecia

Abstract: There is a new form of LPP with clinical features similar to AGA. This form is histopathologically similar to LPP but selectively affects vellus hair follicles.

Cited by 13 publications

References 29 publications

Lichen planopilaris in men: a retrospective clinicopathologic study of 19 patients

Lichen planopilaris in men: a retrospective clinicopathologic study of 19 patients

Dermoscopic features of lichen planopilaris in Northern Iran: a prospective observational study

Clinicopathological characteristics and treatment outcomes of fibrosing alopecia in a pattern distribution: A retrospective cohort study

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