PHOTO GALLERY. CLINICAL VARIANTS OF LICHEN PLANUS WITH LESIONS OF THE SCALP

Lichen planus (LPP) is a chronic inflammatory disease of the skin and mucous membranes, less often affecting the nails and hair, the typical elements of which are lichenoid papules. When LP is localized on the scalp, a follicular form of the disease occurs (LPP, from latin: lichen planopilaris), the outcome of which is cicatricial alopecia. The follicular form of LP can be presented in the form of 4 clinical variants: classic flat lichen, frontal fibrosing alopecia, Graham-Little Piccardi-Lassuer syndrome, fibrosing alopecia with characteristic distribution (FAPD), combining the features of LPP and androgenetic alopecia. Despite the various clinical manifestations, all variants of the follicular form of LP are characterized by the formation of one or more foci of cicatricial alopecia, the presence of erythema of the scalp. Itching is a common symptom and can be of varying intensity; trichodynia - pain in the scalp - is often encountered. Some patients may have typical manifestations of LP on other areas of the skin and oral mucosa. In the active stage of the disease, dermatoscopy reveals perifollicular hyperkeratosis in the foci of alopecia with the formation of scales in the form of tubes at the base of the hair (hair casts), diffuse or perifollicular erythema, milky-red zones of developing fibrosis. The hair "tension" test will be positive in areas of active inflammation and is characterized by the production of anagen hair with an internal epithelial sheath. In the remission stage, foci of cicatricial alopecia with individual preserved hairs remain, and the presence of growth zones of "tufted" hair (tafted hairs); during dermatoscopy, loss of follicle mouths, which is defined as "white dots", no inflammation. The diagnosis is based on the clinical picture, trichoscopic signs, and, if necessary, on the data of a histological examination, which is carried out in the clinically active area of the lesion. The morphological sign of the disease is the presence of a perifollicular lymphocytic infiltrate with destruction of the sebaceous glands. Such patients are recommended to undergo a general clinical laboratory examination, screening for thyroid diseases; many authors consider the need for testing for viral hepatitis. It is recommended to conduct photo documentation before and during treatment to assess the clinical dynamics of alopecia, as well as trichoscopy to monitor inflammatory changes.

We present to your attention a photo gallery of various clinical variants of the follicular form of keratoconus on the scalp.