Lichen planopilaris (LPP) is a form of lichen planus that primarily affects the scalp, leading to scarring hair loss. It is a chronic inflammatory condition, and treatment is aimed at controlling symptoms and preventing further hair loss. Treatment often involves a combination of topical, oral, and sometimes injectable therapies. The following are common approaches to LPP treatment:

1. Topical Treatments

• Topical corticosteroids: High-potency corticosteroids can help reduce inflammation on the scalp. These are usually applied directly to affected areas to decrease redness and itching.
• Topical calcineurin inhibitors: Medications such as tacrolimus or pimecrolimus may be used as alternatives to steroids to reduce inflammation without the risk of skin thinning associated with long-term steroid use.

2. Oral Medications

• Oral corticosteroids: Prednisone or other systemic steroids can be used in short courses to reduce severe inflammation, especially in active or aggressive cases.
• Hydroxychloroquine: An anti-malarial drug often used in autoimmune conditions, hydroxychloroquine is frequently prescribed for LPP to reduce inflammation.
• Immunosuppressive agents: Drugs like methotrexate, mycophenolate mofetil, or cyclosporine may be considered in cases resistant to other treatments. These help suppress the immune system and control inflammation.
• Tetracyclines: Doxycycline and minocycline, which have anti-inflammatory properties, may help reduce scalp inflammation.
• Retinoids: Oral retinoids like acitretin can help treat severe cases of LPP, though they can cause side effects.

3. Injectable Therapies

• Intralesional corticosteroid injections: Triamcinolone injections can be administered directly into areas of inflammation on the scalp to reduce localized inflammation and stop progression.

4. Other Therapies

• Platelet-rich plasma (PRP): Though not universally used, some doctors use PRP injections to promote hair regrowth and reduce inflammation, although its efficacy in LPP is still being studied.
• Laser therapy: Low-level laser therapy (LLLT) may be considered as a supportive treatment to promote hair growth.

5. Lifestyle and Supportive Care

• Avoid triggers: Patients should avoid irritants that could worsen the condition, such as harsh shampoos or tight hairstyles.
• Sun protection: Protecting the scalp from UV exposure with hats or sunscreen may help prevent flare-ups.
• Scalp care: Gentle scalp care, avoiding excessive scratching, and keeping the scalp clean can help reduce symptoms.

6. Monitoring and Long-Term Management

• LPP is a chronic condition, and relapses may occur. Regular follow-up with a dermatologist is crucial to adjust treatments and monitor disease activity.

Since treatment response varies between individuals, a combination approach often works best, and it may take time to find the most effective regimen.