Líquen plano pilar: a importância do diagnóstico precoce The biopsy’s result was consistent with lichen planopilaris and the patient. Lichen planopilaris (LPP) is an uncommon inflammatory scalp disorder that is clinically characterized by perifollicular erythema, follicular. Lichen planopilaris is a frequent presentation of primary cicatricial alopecia. .. cicatriciais causadas por lúpus eritematoso discoide e líquen plano pilar.
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Lichen planopilaris is a frequent presentation of primary cicatricial alopecia. Scalp distribution characterizes the main clinical presentations: Description of pioaris clinical, dermoscopic and histopathological findings of Lichen planopilaris in public and private practices.
A retrospective observational study was performed by reviewing medical records of patients with lichen planopilaris.
Liqufn presentation of Lichen planopilaris varies. To recognize the heterogeneity of the clinical appearance in lichen planopilaris is important for differential diagnosis. Lichen planopilaris is a common form of primary cicatricial alopecia. Lymphocytic inflammatory process occurs at isthmus level destroying the follicle germ cells.
Distribution of the lesions on the scalp characterize the main clinical forms. Three clinical variants of liqen lichen planopilaris can be classically observed: It was initially described only in postmenopausal women, but several cases have been reported in premenopausal women and even in men.
Patient presenting classic form of lichen planopilaris with alopecia plaques at the vertex. Patient with advanced frontal fibrosing alopecia characterized by progressive cicatricial alopecia affecting the implant hairline in pilarls frontotemporal region.
An observational and retrospective study was performed through review of medical records of patients diagnosed with lichen planopilaris. Histological findings of lymphocytic cicatricial alopecia with perifollicular infiltrate at the isthmus were essential for inclusion in the study.
This finding should be linked to at least one of the following: Dermoscopic criteria for exclusion were: The study excluded patients without histological confirmation of lymphocytic cicatricial alopecia.
A total of 80 patients was included in the study. A standard questionnaire was formulated. Among the questions assessed were demographics age, gender and skin type and also data related to the disease, such as disease duration, clinical form, distribution of lesions on the scalp, involvement of other hairy areas, simultaneous diagnoses on the pilaros, other sites of lichen planus, local symptoms, liiquen on clinical and dermoscopic examination, histopathologic findings, previous and current treatments and serology for hepatitis.
Questions were answered by the researchers using data obtained from ;ilaris records.
In some cases it was not possible to fill the pkano due to lack of data in retrospective notes. The descriptive analysis of the data was made by building contingency tables for categorical variables. For continuous variables, some descriptive measures were calculated: To compare patient groups, the chi-square test was applied when the conditions for using the test were met.
Of the 80 patients, 73 Regarding the phototype, 53 The two groups of patients public and private practice showed similar profiles. There was no significant difference between the groups regarding age. Classic form of LPP was found in 50 Concerning the distribution of alopecia plaques on the scalp, 47 Loss of hair in the lower limbs was seen in 9 Involvement of eyelashes was noted in 3 3.
Seven patients presented involvement of other areas by LP. Two patients with LPP had pterygium nail. A patient with FFA had involvement of the 20 nails. All included patients underwent at least a scalp biopsy; 29 patients underwent more than one biopsy at different times. The remaining 17 cases showed scattered lymphocytes and perifollicular fibrosis, “onion skin-like”, with follicular consumption.
Among the dermoscopic findings, perifollicular hyperkeratosis was observed in 15 patients, white spots in 12 patients, isolated strands in 6 patients and perifollicular hyper-pigmentation in 2 patients. Patients were subdivided into 3 groups according to clinical aspect.
Classic LPP was considered when confluent random plaques were observed. FFA was considered in patients with alopecia in the line of hair implant of frontotemporal region.
In the classic LPP group it was possible to characterize 2 distinct clinical features. One group with confluent random plaques distributed throughout the scalp and other with confluent plaques in the central region of the scalp, clinically similar to male pattern or female pattern androgenetic alopecia, what is called fibrosing alopecia in a pattern distribution FAPD.
This variant has increasingly been described as a variation of LPP; although clinically similar to male pattern or female pattern androgenetic alopecia, the perifollicular linchenoid inflammatory process histologically characterizes this entity Figure 3.
Patient with fibrosing alopecia in a pattern distribution showing confluent alopecia plaques in the central region of the scalp. Regarding the dermoscopic findings, 54 of the 80 cases presented description of dermoscopic examination in the medical records.
The dermoscopic findings are shown in table 1. Among the treatments employed, 65 patients used antimalarials, 53 used topical minoxidil and 30 patients used intralesional corticosteroids.
The use of topical corticosteroids was observed in 52 patients, of systemic corticosteroids in 19 patients, of antibiotics in 9 patients and of mycophenolate mofetil in 3 patients. Phototype II was the most frequently affected: Lichen planopilaris, also called follicular lichen or follicular lichen planus, pllaris initially described by Pringle in As in lichen planus, its etiology is not well understood and most often affects white women.
Nail involvement occurred in 8. Differential diagnosis of cicatricial alopecia lqiuen a clinical challenge to pilsris dermatologist. Diagnosis of LPP is suspected in the presence of cicatricial alopecia plaques, single or multiple, presenting perifollicular hyperkeratosis, erythema, mainly on the periphery of scarring lesion.
Itching, stinging and burning may also be present. Among the most frequently observed dermoscopic findings, perifollicular hyperkeratosis and reduction of the number of follicles was observed in These data are similar to those previously described in the literature. Black dots are classically described in patients with AA and trichotillomania but had pilarus yet been observed in patients with LP.
These patients had no other associated diagnoses that could justify these findings.
Orphanet: Liquen plano pilaris
As with AA, these dots may be due to disease activity or external manipulation of the stalks in processes to camouflage the flaws, which may break strands and form black dots, similar to what occurs in trichotillomania. LPP is a diagnostic challenge. Clinical, dermoscopic and histopathologic findings may provide data for a definitive diagnosis.
Dermoscopy of LPP is not characteristic, but associated with clinical and histological findings of cicatricial alopecia, to define the diagnosis.
Clinical spectrum of LPP is varied. Classic form of LPP was responsible for more than half In the current sample, an uncharacteristic group was evident, but already discussed in cicatricial alopecia consensus. It was possible to distinguish FAPD from the other 3 groups by the central and diffuse involvement of the scalp Figure 1.
LPP cases have been described after hair transplant surgery and thus considered as a Koebner phenomenon, but they might actually be misdiagnosed FAPD, treated as androgenetic alopecia.
White areas described classically in LPP are irregular white spots that can come together forming white-cicatricial areas. Isolated strands are seen in cicatricial alopecia and correspond to the previous sites of inflammation with loss of follicles on the site. Perifollicular halo or target hyperpigmentation are seen as perifollicular blue-gray dots that correspond histologically to pigment leakage that occurs in LPP interface dermatites.
Presence of elongated blood vessels arranged parallel to each other can be found in the periphery of LPP active plaques. Since the description of the first 6 cases in Brazil inseveral cases have been evaluated, suggesting that this entity is actually underdiagnosed and not rare. Treatment of LPP is controversial and often disappointing. As a cicatricial alopecia, the main goal of therapy is to prevent the progression of the lesions.
Early diagnosis and intervention can change the course of the disease. Among the treatment options available, the evaluated group used topical, intralesional and systemic corticosteroids; hydroxychloroquine; acitretin; and mycophenolate mofetil. Other options, such as cyclosporine, thalidomide and griseofulvin, have been used with variable response, but were not used by the patients included in this sample.
Clinical presentation of LPP is diverse. Recognition of forms of LPP initial presentation is critical to the dermatologist, since this is a cicatricial alopecia that requires early intervention. Early forms may present mild hair loss so other differential diagnoses must be considered. Dermatoscopy and scalp biopsy complement the evaluation of LPP.
The study presents as limitation the fact that data were collected through medical records review, which may present some incomplete or distorted information. How to cite this article: National Center for Biotechnology InformationU.
Journal List An Bras Dermatol v. Find articles by Vanessa Cristina Soares. Find articles by Fabiane Mulinari-Brenner. Find articles by Tatiane Elen de Souza.
Author information Article notes Copyright and License information Disclaimer. Received Aug 9; Accepted Nov This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. METHOD A retrospective observational study was performed by reviewing medical records of patients with lichen planopilaris. Open in a separate window. METHODS An observational and retrospective study was performed through review of medical records pilagis patients diagnosed with lichen planopilaris.