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Lichen Planopilaris with Pustules: A Diagnostic Challenge
Karina L Morais1, Cintia F Martins1, Alessandra Anzai1
1Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil.
Skin Appendage Disorders
|May 17, 2018
Summary
Lichen planopilaris (LPP) can present with pustules, mimicking other scalp conditions. Early and accurate diagnosis is crucial to avoid misdiagnosis and ensure proper treatment for this scarring alopecia.
Area of Science:
- Dermatology
- Trichology
- Pathology
Background:
- Lichen planopilaris (LPP) is a primary cicatricial alopecia characterized by scarring hair loss, perifollicular erythema, and scaling.
- Pustules are an uncommon finding in LPP, potentially leading to misdiagnosis as neutrophilic alopecias like folliculitis decalvans (FD).
Purpose of the Study:
- To describe cases of LPP presenting with pustules.
- To highlight the importance of differentiating LPP with pustules from primary neutrophilic folliculitis.
Main Methods:
- Retrospective analysis of 13 LPP cases with pustules.
- Inclusion of demographic, clinical, histopathological, and follow-up data.
- Cases were followed at the Department of Dermatology, University of São Paulo Medical School.
Main Results:
- The study included 13 patients (7 females, 6 males) aged 23-61 years.
- Previous misdiagnoses included FD (3 patients), pityriasis amiantacea (2), and folliculitis keloidalis nuchae (1).
- Seven patients presented with typical LPP features alongside pustules.
Conclusions:
- LPP with pustules requires consideration as a differential diagnosis for refractory folliculitis.
- Thorough scalp examination, dermoscopy, and reevaluation after antibiotics can prevent misdiagnosis.
- Further research is needed to understand the cause of pustules in LPP.
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