Lichen Planopilaris (Scarring Alopecia) ICD-10: L66.1

Autoimmune / Scarring hair loss condition

Often searched as: permanent hair loss scalp, bald patches that won't grow back, scarring hair loss, red scaly scalp with hair loss, smooth shiny bald patches, burning itchy scalp hair loss, hairline receding with inflammation, eyebrow hair loss with scalp…

Clinical urgency level

lowmediumhigh

Systems Affected

scalphair follicleseyebrows and eyelashes (in some variants)

Severity Levels

mild

Small, stable patches of follicular inflammation on the scalp, minimal active hair loss — manageable with topical corticosteroids and anti-inflammatory agents.

moderate

Multiple expanding patches with active inflammation (redness, scale, itch, burning), ongoing hair loss — requires systemic treatment (hydroxychloroquine, oral retinoids).

severe

Rapidly progressive, widespread scalp involvement with extensive irreversible hair loss, or frontal fibrosing alopecia variant with progressive frontal hairline recession — requires aggressive immunosuppressive treatment and urgent specialist care.

Red Flags

Scalp patches spreading rapidly over weeks to months
Progressive recession of the frontal hairline — possible frontal fibrosing alopecia variant
Loss of eyebrows alongside scalp hair loss
Burning, pain, or severe itch in a bald patch on the scalp
Bald areas with no visible follicular openings (smooth, shiny skin) — indicates scarring and irreversible loss
No response to treatment after 3–4 months

Clinical Presentation

Lichen planopilaris — smooth scarred scalp patches with perifollicular redness and scale

View gallery on DermNet NZ (image gallery reference)

Frontal fibrosing alopecia — progressive frontal hairline recession with perifollicular erythema

Source: Wikimedia Commons (CC BY-SA 3.0 )

When to See a Doctor

See a dermatologist urgently if you notice patchy hair loss with redness, scaling, or burning — especially if the bald patches feel smooth and shiny (indicating follicle destruction). Scarring alopecia is irreversible once established; early treatment is the only way to preserve remaining hair. Don't wait to see if it resolves on its own.

Differential Diagnosis

Alopecia areata (non-scarring — smooth patches, hair can regrow)
Discoid lupus erythematosus (scarring — hypopigmentation and scarring in center)
Central centrifugal cicatricial alopecia (CCCA — in Black women, crown-centered)
Folliculitis decalvans (pustular, scarring — bacteria-associated)
Tinea capitis (fungal — especially in children, boggy kerion)
Frontal fibrosing alopecia (FFA — LPP variant with frontal recession)

Comorbidities

Lichen planus (skin or mucosal — may coexist)
Thyroid disease
Other autoimmune conditions
Frontal fibrosing alopecia (variant with progressive frontal recession — associated with sunscreen chemicals and postmenopausal status in women)
Depression and anxiety (permanent hair loss has significant psychological impact)

Prognosis

Lichen planopilaris causes permanent, irreversible scarring of hair follicles — hair lost in established scarred areas will not regrow. The goal of treatment is to stop or slow progression and preserve remaining follicles. Anti-inflammatory treatments (topical and intralesional corticosteroids, hydroxychloroquine, retinoids) can achieve disease stabilization in many patients. Frontal fibrosing alopecia (FFA), a variant, has become increasingly common and often requires combination therapy. Early diagnosis and treatment are critical to minimize permanent hair loss.

Detailed Overview

Causes, Symptoms, and When to Take Action Lichen planopilaris is a rare and inflammatory condition affecting hair follicles, leading to permanent scarring hair loss. Early recognition and monitoring are crucial, as hair loss may be irreversible. How It Looks Texture: Smooth, shiny scalp patches lacking visible hair follicles Color: Red, inflamed skin often with surrounding scaling Shape: Patchy or multifocal areas that may merge into larger bald regions Location: Primarily affects the scalp; may also involve eyebrows, eyelashes, or other hair-bearing areas Why Does It Appear? While the exact cause remains unclear, lichen planopilaris is thought to be an autoimmune disorder in which immune cells target hair follicle stem cells, leading to follicular destruction and scarring. Should You Be Concerned? Yes — because it causes permanent hair loss through scarring. You should consult a healthcare provider if you notice: Patchy, smooth bald areas on the scalp Redness, scaling, itching, burning, or tenderness in these areas Progressive spread of hair loss Early evaluation is essential to slow progression and protect remaining hair follicles. Can You Prevent It? There is no known prevention. However, you can help reduce harm by avoiding trauma to hair-bearing skin, monitoring your scalp regularly, and seeking professional evaluation promptly when symptoms appear. 👉 How Piel AI Can Help Piel AI helps you track scalp changes by enabling regular imaging of affected areas. While it is not diagnostic, it supports identifying progression patterns and enhances discussions with healthcare professionals. Summary Lichen planopilaris is an inflammatory, scarring hair loss condition. It presents as smooth, red, and often itchy patches without visible hair follicles. The cause is likely autoimmune, targeting follicle stem cells. Early detection and care are key to managing progression.

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