Lichen planopilaris

Age: 44 years
Gender: Male
Site: Scalp
Duration: 6 months
History:
Mild itching and burning sensation
Negative history of relevant drug intake
Findings:
* Localized purplish patches with hair loss
* The red-violaceous patches are mainly perifollicular
* Some hair follicles are completely destructed (whitish scarred areas) others still seen!
* Some hair loss was due to androgenetic alopecia (unrelated to lichen planopilaris)
* No mucous membrane, other cutaneous or nail involvement
Diagnosis: Primarily clinical (The patient refuse taking skin biopsy)
Treatment:
1. Clobetasol propionate 0.05% ointment applied once at night plus Tacrolimus 0.1% ointment applied once at morning
2. Hydroxychloroquine 200 mg twice daily orally (After ophthalmologic examination and relevant serological tests had been done)
Response: Follow up after 2 months showed disappearance of the symptoms and decreasing intensity of the inflammation with some hairs regrowth again.
According to the degree of response, other measures can be tried like: Tetracycline eg doxycycline, Acitretin, Methotrexate, Ciclosporin, Mycophenlate mofetil and the oral antidiabetic: Pioglitazone (PPAR-γ agonist).