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Published on: January 27, 2018
Lichen planopilaris in men: a retrospective clinicopathologic study of 19 patients
Hafsa M Cantwell1, Carilyn N Wieland1,2, Sydney L Proffer3
1Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
Background:
Lichen planopilaris (LPP) is a scarring alopecia rarely described in men.
Objective:
To investigate the clinical and histopathologic features of LPP in men.
Methods:
We performed a retrospective cohort study of male patients with LPP seen at Mayo Clinic between 1992 and 2016.
Results:
Nineteen men with biopsy-confirmed LPP were included. The disease most commonly presented with diffuse (42.1%) or vertex scalp (42.1%) involvement. None of the patients had eyebrow or body hair involvement. Perifollicular erythema (94.7%) and pruritus (57.9%) were the most frequent clinical findings. Androgenetic alopecia (AGA) co-occurred in 26.3% of patients. Mucosal lichen planus was found in four patients (21.1%). Thyroid disease occurred in three patients (15.8%). Disease improvement (47.3%) occurred with combination topical and systemic therapy, topical clobetasol monotherapy, and minocycline monotherapy.
Conclusions:
LPP in men has similar clinical and histologic presentations as reported in women. Nonscalp hair loss appears less likely in men with classic LPP than reported in men with frontal fibrosing alopecia, while mucosal lichen planus and thyroid disease appear to be more common in classic LPP. Men with AGA can present with new-onset concomitant LPP. Limitations included small study size, variable follow-up, and lack of standardized clinical assessment due the study's retrospective nature.
Insights
Lichen planopilaris (LPP) in men presents similarly to women, often affecting the scalp diffusely or at the vertex. Associated conditions like mucosal lichen planus and thyroid disease are more common in men with LPP.
Area of Science:
- Dermatology
- Trichology
- Pathology
Background:
- Lichen planopilaris (LPP) is a rare scarring alopecia, with limited data on its presentation in males.
- Understanding male LPP is crucial for accurate diagnosis and management.
Purpose of the Study:
- To delineate the clinical and histopathologic characteristics of LPP specifically in a male cohort.
- To identify common presentations, associated conditions, and treatment responses in men with LPP.
Main Methods:
- Retrospective cohort study design.
- Inclusion of biopsy-confirmed male LPP patients from Mayo Clinic (1992-2016).
- Analysis of clinical presentation, histopathology, comorbidities, and treatment outcomes.
Main Results:
- Nineteen male patients with LPP were analyzed.
- Common presentations included diffuse or vertex scalp involvement (42.1% each).
- Perifollicular erythema (94.7%) and pruritus (57.9%) were frequent; no eyebrow/body hair loss noted. Co-occurrence with androgenetic alopecia (26.3%), mucosal lichen planus (21.1%), and thyroid disease (15.8%) observed.
- Disease improvement achieved in 47.3% with combination therapy, topical clobetasol, or minocycline.
Conclusions:
- Male LPP shares clinical and histologic features with female LPP.
- Nonscalp hair loss is less common in male LPP compared to frontal fibrosing alopecia.
- Mucosal lichen planus and thyroid disease appear more prevalent in male LPP.
- Androgenetic alopecia can coexist with LPP in men.
- Limitations include small sample size and retrospective design.
