Lichen planus pilaris is a chronic disease of the scalp that is characterized by a strong inflammation of the hair follicles. There is currently no treatment to permanently cure the disease. Even if the disease regresses after 18 to 24 months, it is important to start a treatment as soon as possible to avoid irreversible scarring alopecia. In most cases, existing medications can limit the outbreaks of the disease and its consequences on the scalp.
What is the treatments’ objective?
The objective of the treatments is threefold:
- prevent lichen planus flare-ups
- stop the spread of lesions
- prevent the appearance of permanent scarring alopecia
What medications are recommended for lichen planus?
Corticosteroid therapy is the main treatment choice to treat lichen planus. Depending on the case, it will involve the use of:
- Class I dermocorticoids (clobetasol propionate type): available in the form of creams, lotions or ointments. These dermocorticoids must be applied directly to the inflamed areas, on the edge of the alopecic patches. This treatment cannot be taken over a long period of time, as the skin may atrophy as a side effect.
- Intradermal corticosteroids: the doctor may prescribe corticosteroid injections into the scalp, again on the edge of the alopecic patches, in combination with dermocorticoids.
- Systemic corticosteroids: oral cortisone derivatives are commonly used to stop lichen planus flare-ups and prevent relapses. The treatment lasts from three to six months.
If the treatment is not successful, other medical options such as antimalarials (hydroxychloroquinine), ciclosporin or methotrexate may be considered.
How to treat scarring alopecia caused by lichen planus pilaris?
Unfortunately, scarring alopecia caused by lichen planus is irreversible. The hair follicles are permanently destroyed by the inflammation and they cannot be revived. On the other hand, modern reconstructive surgery or hair grafting techniques can reduce scars or effectively conceal the alopecic patches, depending on the case.