Facial Lichen Planopilaris Mimicking Melasma: A Case Report Emphasizing the Value of Clinicopathologic Correlation

Lichen planopilaris (LPP) is a rare, immune-mediated cicatricial alopecia characterized by perifollicular erythema, hyperkeratosis, and progressive hair follicle destruction, leading to permanent hair loss. While LPP typically affects the scalp and is classified into classic LPP, frontal fibrosing alopecia (FFA), and Graham-Little-Piccardi-Lassueur (GLPL) syndrome, atypical presentations involving extra-scalp regions, including the face, are exceedingly rare. We present a unique case of melasma-like LPP manifesting on the face, a highly unusual presentation that posed diagnostic challenges due to its resemblance to hyperpigmentary disorders. A 38-year-old man presented with an asymptomatic hyperpigmented patch on the cheek and forehead mimicking melasma. This case highlights the importance of considering LPP in the differential diagnosis of facial hyperpigmentation, particularly when conventional therapies for melasma fail. It should be noted that histopathology was a valuable tool for the diagnosis of the disease. We recommend including dermoscopic images in future studies to help dermatologists become familiar with the dermoscopic features of LPP and to differentiate between LPP and melasma using dermoscopy.