Lichen planopilaris (LPP) is a relatively uncommon inflammatory condition that affects the scalp, leading to hair loss and sometimes scalp pain. It belongs to a group of conditions known as cicatricial or scarring alopecia, where inflammation leads to the destruction of hair follicles, resulting in permanent hair loss. LPP is a chronic inflammatory condition that primarily affects the hair follicles on the scalp, leading to hair loss and scarring. It is considered a variant of lichen planus, a skin disorder characterized by itchy, flat-topped, purple-colored bumps.
Lichen planus is a lesser-known but impactful skin condition that affects thousands of people worldwide. Often characterized by an itchy, purple rash and painful sores, it can appear on the skin, mouth, scalp, and genital areas. Because it’s an autoimmune condition, the body’s immune system mistakenly attacks its own skin cells, leading to inflammation and discomfort. Lichen planus is an inflammatory disease affecting the skin and mucous membranes. It manifests in various forms, some more common than others, and can significantly impact quality of life depending on severity and location. The precise lichen planus causes are not fully understood, but it is considered an autoimmune condition where the immune system attacks skin cells and mucous membranes.
Hair loss and scalp pain can have significant impacts on an individual’s physical appearance, self-esteem, and overall quality of life. Beyond cosmetic concerns, they can also be indicators of underlying health issues. Living with LPP presents significant challenges, impacting both physical well-being and emotional health. Despite its chronic nature and potential for hair loss and scalp pain, understanding LPP and exploring treatment options offer hope for improved quality of life.
Diagnosing lichen planopilaris typically involves a combination of clinical examination, medical history review, and sometimes additional tests. LPP can have a significant impact on an individual’s quality of life, both physically and emotionally. Beyond the visible symptoms of hair loss and scalp inflammation, the condition may cause discomfort, pain, and itching, leading to distress and anxiety. The visible changes in appearance may also affect self-esteem, social interactions, and overall well-being.
Effective management of lichen planus combines medical treatment with lifestyle adjustments to minimize symptoms and prevent flare-ups. Managing lichen planus symptoms involves consistent care and attention. Regular use of prescribed medications, avoiding irritants, and moisturizing can help control flare-ups. Identifying and steering clear of factors that provoke or worsen lichen planus is crucial. Consulting a healthcare provider or dermatologist is essential for proper diagnosis and effective management of lichen planus. Early intervention can prevent complications, ease symptoms, and improve quality of life.
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Understanding Lichen Planopilaris
The exact cause of LPP is not fully comprehended. However, it is believed to involve a combination of genetic predisposition and immune system dysregulation. LPP is a chronic inflammatory condition that primarily affects the hair follicles on the scalp, leading to hair loss and scarring. Moreover, it is considered a variant of lichen planus, a skin disorder characterized by itchy, flat-topped, purple-colored bumps.
Hair Loss: Types and Patterns in LPP
The loss of hair in LPP typically follows a distinct pattern that differs from other forms of alopecia. In LPP, hair loss often presents patchy areas of baldness, which may have a reddish-brown hue due to associated inflammation. Unlike some other types of hair loss, such as male pattern baldness or alopecia areata, LPP tends to affect the entire scalp rather than specific areas. As the condition progresses, the affected patches may merge, resulting in more widespread hair loss.
Scalp Pain: Nature and Severity
Scalp pain in lichen planopilaris can vary in nature and severity from person to person. Some individuals may experience mild discomfort or tenderness in the affected areas, while others may describe more intense sensations such as burning, itching, or stabbing pains. The scalp pain may be intermittent or persistent and may worsen with certain activities such as washing or styling the hair. In some cases, the pain may be accompanied by inflammation, redness, or sensitivity to touch.
Psychological Effects of Hair Loss and Scalp Pain
The psychological effects of hair loss and scalp pain associated with lichen planopilaris can be profound and multifaceted. Hair loss, in particular, is often closely tied to one’s identity and self-image. So, the visible changes in appearance caused by LPP can lead to feelings of embarrassment, self-consciousness, and low self-esteem. Individuals may also experience anxiety, depression, or social withdrawal as a result of their condition. Especially, if they perceive it as negatively impacting their attractiveness or femininity/masculinity.
The chronic nature of LPP and the uncertainty surrounding its prognosis may further exacerbate these psychological effects. It leads to feelings of frustration, helplessness, and hopelessness. It is essential for individuals living with LPP to receive support not only for the physical symptoms but also for the emotional and psychological toll it may take.
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Treatment Options for Lichen Planopilaris
Lichen planopilaris treatment ranges from medications and phototherapy to lifestyle adjustments and surgical interventions; there are diverse approaches available.
Medications
Topical corticosteroids: Topical corticosteroids are often the first-line treatment for LPP. They help reduce inflammation and relieve symptoms such as itching and scalp pain. These medications are applied directly to the affected areas of the scalp and may be available in various forms, such as creams, ointments, or solutions.
Oral medications: In cases of more severe or widespread LPP, oral medications may be prescribed. Furthermore, corticosteroids taken orally can help suppress inflammation throughout the body, including the scalp. Retinoids, which are derivatives of vitamin A, may also be used to regulate cell growth and reduce inflammation.
Immunomodulators: Immunomodulators may be prescribed to modulate the immune response and reduce inflammation in LPP.
Phototherapy
It involves exposing the scalp to ultraviolet (UV) light, which can help suppress the immune response and decrease inflammation in LPP. Additionally, phototherapy may be administered using various techniques.
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Surgical Interventions
Hair transplantation: Hair transplantation surgery involves removing healthy hair follicles from donor areas of the scalp and transplanting them into bald or thinning areas. While hair transplantation cannot reverse scarring caused by lichen planopilaris, it can help improve the appearance of affected areas and restore hair density.
Scalp reduction surgery: Surgeons may recommend scalp reduction surgery for advanced lichen planopilaris cases with significant scalp scarring. During this procedure, they surgically remove the affected areas of scarred scalp tissue and stretch and reposition the surrounding healthy scalp tissue to cover the defect.
Lifestyle Modifications
- Stress Management Techniques: Stress has been implicated as a potential trigger for worsening LPP symptoms.
The Role of Diet in Managing Lichen Planopilaris
Diet is known to affect a wide range of health disorders. The emerging popularity of anti-inflammatory diets has garnered interest in its use as a potential therapeutic in reducing inflammation in autoimmune conditions. Adopting an anti-inflammatory diet may help manage lichen planus symptoms. Focus on whole foods such as fresh fruits, vegetables, lean proteins, and whole grains.
Determining the relationship between Lichen Sclerosus (LS) and diet on your symptoms, flares, and condition progression can be confusing. Since few scientific studies have looked at the direct impact of diet on LS, they offer little to no insight into such a broad, complex topic. But, even if there aren’t many studies specifically looking at diet concerning LS, we know that LS is a chronic inflammatory skin condition primarily affecting the anus and genitals’ skin. As such, we can better understand how diet impacts LS through research that looks at gut health, diet and inflammation, or diet and immunity. As more research is published, a stronger argument exists to class LS as an autoimmune condition.
Anti-Inflammatory Diet
An anti-inflammatory diet emphasizes whole, fresh vegetables and fruits while limiting processed foods and additives, caffeine, and alcohol to support overall health.
Mediterranean Diet
The Mediterranean diet, which is rich in raw vegetables and fresh herbs, and isoflavone-rich soy contain anti-inflammatory nutrients that may promote hair health and growth in androgenetic alopecia (AGA). Consistent with the role of inflammation in the pathogenesis of AGA, it makes intuitive sense that a diet rich in antioxidant, anti-inflammatory, or estrogenic components − properties found in the Mediterranean diet − could prevent hair loss. These plant-rich diets contain phytochemicals, such as carotenoids and polyphenols, with anti-inflammatory and antioxidant properties which can reduce the production of reactive oxygen species in the dermal papilla cells, leading to the reduced secretion of transforming growth factor β1 and stimulation of hair growth.
Gluten-Free Diet
The gluten-free diet was shown to stimulate hair growth in alopecia areata (AA) patients with concomitant celiac disease, though no effect was seen with a lactose-free diet. Celiac disease is associated with AA; both contain organ-specific autoantibodies and show T-lymphocyte infiltration and association with HLA genes. All AA patients who improved after a gluten-free diet had celiac disease, suggesting that the removal of gluten not only calmed down the inflammation and normalized the gut microbiota, but also positively impacted the scalp.
Protein Intake
Sufficient protein was found to be necessary for hair health. Proteins are the major components of hair. A cross-sectional study found severe protein intake deficiencies in Indian AGA, AA, and TE patients, supporting protein as an essential nutrient for hair.
Foods to Consider Limiting or Avoiding
- High Oxalate Foods: In the clinic, I find that if a client has a hard time breaking down oxalates and they have LS, then consuming a diet rich in oxalates can absolutely cause flares.
- Histamine-Releasing Foods: Allergic reactions and sensitivities to dietary histamine, also known as histamine intolerance, are inappropriate histamine responses.
- High-Sugar Foods: The Standard American Diet (SAD) and the consumption of high-sugar soft drinks often lead to an elevated blood glucose level known as hyperglycemia.
- Dairy: Another key component of the Standard American Diet is dairy, especially milk fats and milk solids, which are major components of processed, shelf-stable foods.
- Gluten: Beyond celiac disease, gluten, or more specifically gliadin, the protein found in wheat, has been shown to cause non-celiac gluten sensitivity, activating T-cells and triggering a pro-inflammatory response associated with autoimmunity.
Elimination Diet
An elimination diet provides a way to identify food triggers by eliminating all foods that you suspect may be causing inflammation, and then reintroduce them one at a time.
Autoimmune Protocol (AIP)
If you’ve ever spent time researching a diet that may help you manage your LS symptoms, you’ve surely come across the Autoimmune Protocol or AIP. Following AIP has led to many LS success stories!
Additional Considerations
The Gut Microbiome
The role of the microbiome in AA has been of recent interest. Gut bacteria may degrade the intestinal epithelial barrier leading to inflammation and autoimmunity, highlighting the possibility that changes in diet may influence the gut microbiota.
Polyphenols
Polyphenols, compounds found in plant substances that have antioxidant properties, were found to inhibit 5α-reductase, suggesting a potential role for diets in AGA treatment.
Buckwheat and Millet Groats
One study showed an association between buckwheat and millet groats consumption in FFA patients, suggesting a potential role in its pathogenesis.
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