Lichen planopilaris: what it is and how it is treated

Lichen planopilaris (LPP) is an inflammatory condition in which the immune system attacks hair follicles and replaces them with scar tissue. Because scarred follicles cannot regrow hair, the goals of treatment are to relieve symptoms and stop the disease from spreading, which makes early diagnosis important.

What are the symptoms?

LPP usually affects the top or sides of the scalp. Hair thins in patches, often with redness and scaling around the hairs, and many people feel itching, burning or tenderness of the scalp. A dermatologist confirms the diagnosis by examining the scalp, often with a biopsy.

How is it treated?

A 2026 position statement from the European Academy of Dermatology and Venereology (EADV) task force on hair diseases summarises the approach:

• First line: potent corticosteroids applied to the scalp or injected into affected areas, alone or with other treatments.
• Moderate to severe or progressive disease: systemic treatment or a combination, tailored to disease activity, other health conditions and patient preference.

The statement is frank about the limits: there is no known cure, randomised trials are few and no treatments have been compared head to head. A 2021 practical review likewise notes that most evidence comes from case reports and case series, and that responses vary.

What is research exploring?

Professor Nilforoushzadeh's group reported a patient with LPP unresponsive to standard treatment who showed preliminary signs of better symptom control and hair preservation after adipose-derived exosomes. It is a single case, a reason to study the approach further rather than evidence that it works.

Can people with LPP have a hair transplant?

Only in selected cases, once the disease has been inactive for some time, because inflammation can attack the grafts and scar tissue has a poor blood supply. Preparing the scalp before surgery has been reported in a related condition. For how LPP fits among the other causes of hair loss, see the hair restoration guide.