Pictorial case study: lichen planus of the scalp

A 35-year-old woman presented with localised hair loss from her scalp, which was also itchy.

 

On examination, there was scaling and mottled hyper-pigmentation within areas of scarring. She also had reddish purple patches and plaques that had enlarged over a few months. The patient was otherwise well. What is the diagnosis and management? What is the differential diagnoses?  

Diagnosis and management  

This diagnosis is lichen planus of the scalp, also known as lichen planopilaris.  

This is a common condition of unknown aetiology that might have an autoimmune component. Skin biopsy will help confirm the diagnosis.  

Refer to a dermatologist for immediate treatment because the hair loss may be permanent.  

Treatment may include steroids, ciclosporin or acitretin.  

Possible different diagnosis  

Seborrhoeic dermatitis.  

Psoriasis of the scalp.  

Contact dermatitis of scalp.  

Discoid lupus erythematosus.  

Differential diagnoses  

Discoid lupus erythematosus  

Autoimmune disease.  

Bald, red, scaly patches.  

Thinning of skin and capillaries may be seen.  

Loss of follicles, perfollicular erythema, keratosis.  

Hair loss is permanent.  

Contributed by Dr Vasa Gnanapragasam, a GP in Sutton, Surrey  

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