Lichen planopilaris (LPP), in its classic form, is the most frequent cause of primary alopecia in adults. LPP affects women twice as often as men. The disease proceeds with irreversible hair loss as a result of hair follicles damage by an autoimmune process.

Symptoms
Typically, at the beginning, the presence of reddish or violaceous papules or erythematous areas may be observed, which is accompanied by scalp scaling. The lesions often occur in the parietal and vertex area. A frequent accompanying symptom is itching and tenderness of the affected scalp. These conditions are sometimes worsened by sweating, exposure to sun, irritation and stress. When inflammatory symptoms subside, focal or diffuse alopecia may be observed, which gives an image of confluent white dots or milky-red areas.

Course of disease
The disease is often progressive, although its activity may vary between different people. At first, the affected small areas may tend to become confluent and affect large areas of the scalp. In places of scar formation, hair regrowth is impossible.

Diagnosis
The diagnosis is possible based on clinical picture and trichoscopy procedure. Sometimes, a skin pathology test is needed.

Treatment
In the early period of the LPP, the most important treatments are anti-inflammatory drugs, such as corticosteroids and retinoids. Some authors stress the effectiveness of hydroxichloroquine, cyclosporin and mycophenolate mofetil. The latest reports refer to PPAR modulators.