Lichen planopilaris-like changes arising within an epidermal nevus: does this case suggest clues to the etiology of lichen planopilaris?

Lichen Planopilaris Developing at the Margins of a Sebaceous Nevus of Jadassohn: Co-existence or Etiologic Association?

Sebaceous nevus (SN), is a skin hamartoma, combining a variety of epidermal, follicular, sebaceous, and apocrine abnormalities. Although usually present at birth, it may become apparent later in life appearing as a yellowish-brown, verrucous plaque with alopecia. SN is implicated with secondary tumors arising on the hairless plaque during the adulthood. Lichen planopilaris is a common, primary lymphocytic scarring alopecia of unknown etiology, characterized by lichenoid/interface perifollicular lymphocytic infiltrate occurring at the level of the infundibulum and the isthmus. Here, we present a case of a 48-year-old Caucasian male with lichen planopilaris lesions developing at the periphery of a preexisting SN. Our case raises the question, whether the development of lichen planopilaris was coincidental, or is it indicative of an etiologic association between the lichen planopilaris and SN.

Break dancing: a new risk factor for scarring hair loss

BACKGROUND

We report on a first case of lichen planopilaris (LPP) mimicking androgenetic alopecia (AGA) in an individual who has been break-dancing on his head for many years. LPP is an autoimmune inflammatory scalp condition that when left untreated can result in scarring and irreversible hair loss. The etiology of LPP is unknown. Different treatment modalities are used for LPP and AGA.

OBJECTIVE

To increase the awareness of physicians to the possibility of scarring hair loss (LPP) presenting like AGA.

RESULTS

Scalp examination showed scarring patches of hair loss. A scalp biopsy confirmed the diagnosis of LPP.

CONCLUSION

Chronic scalp trauma due to break dancing may be a trigger for LPP. A meticulous scalp examination should be performed before making a diagnosis of nonscarring conditions of hair loss such as AGA. Early recognition of LPP and appropriate treatment are important before scarring and irreversible hair loss ensue.

Update on primary cicatricial alopecias

The cicatricial alopecias encompass a diverse group of disorders characterized by permanent destruction of the hair follicle and irreversible hair loss. Destruction of the hair follicle can result from primary, folliculocentric disease or as a secondary result. This article focuses on the former, or primary cicatricial alopecias. The cause and pathogenesis of many of these disorders are largely unknown. Although unique clinicopathologic features allow for accurate diagnosis in some cases, diagnostic certainty is often elusive and reflects the limits of present understanding. Classification of the primary cicatricial alopecias on the basis of pathology provides a diagnostic and investigational framework and, it is hoped, will facilitate future enlightenment. Details of classification, etiopathogenesis, clinicopathologic features, differential diagnosis, and practical management of the primary cicatricial alopecias will be discussed.

LEARNING OBJECTIVES

Upon completion of this learning activity, participants should be familiar with the following aspects of the primary cicatricial alopecias: (1) the new, consensus-issued classification scheme, (2) current understanding about etiopathogenesis, (3) salient clinicopathologic features, (4) differential diagnosis, and (5) therapeutic management.