Lichen planopilaris

P, a 20-year-old laborer displayed initial symptoms of the disease in quest ion when he was 10 years old. Initially he had an asymptomatic progressive loss of hair on the scalp. A couple of years later he had mild to moderate pruritis, and the appearance of slate-blue eruptions on the scalp and elsew here on the body. This resulted in a complete loss of hair on the vault of the scalp, which led him to seek specialist opinion. Skin surface examinati on revealed the presence of grayish-blue acuminate follicular papules, disp osed singly and in groups (plaques). The pilo-sebaceous orifices were consp icuously obliterated and filled by keratin plugs. Perifollicular erythema w as a predominant feature on the scalp. The lesions were present over the sc alp, around the neck, chest, back, axillae, groin and legs. Shiny atrophied scalp skin depicting scarring alopecia mimicking male-type baldness was a salient feature. In addition, it was studded with conspicuous acuminate pap ules in its center (Fig, 1a). The known nonhairy (glabrous) skin had classi c lichen planus lesions (Fig. 1b). Hemotoxylin-eosin stained microsections prepared from typical lichen planus (LP) lesions over the abdomen and those of lichen planopilaris (LPP) of th e scalp were simultaneously studied. The former revealed changes in the epi dermis comprising of hyperkeratosis, increase in thickness of stratum granu losum, hydropic degeneration of the basal cell layer and band-like lympho-h istiocytic infiltrate pressing against and invading the epidermis, while th e latter revealed uniform atrophy of the epidermis and vacuolization of bas al cells. The hair follicles were dilated and were filled with keratin plug s. In addition to fibrosis of the dermis, pigment laden microphages and lym pho-histiocytic infiltrate was prominent. The follicles and the sebaceous g lands were absent. However, arrectores pilorum and sweat glands were preser ved (Figs 2a and b).