Lichen Planopilaris and Lichen Planus Pigmentosus: Current and Emerging Therapies

The discussion focuses on challenging forms of lichenoid dermatoses, particularly Lichen Planopilaris (LPP) and Lichen Planus Pigmentosus (LPPg). Scarring alopecia, characterized by inflammation affecting hair follicle stem cells, is highlighted, with LPP traditionally regarded as a prototypical form. However, Frontal Fibrosing Alopecia (FFA) has become more prevalent, and both conditions exhibit similar inflammatory patterns. Treatment assessment involves evaluating disease activity, often requiring serial measurements to ensure accurate monitoring. Current therapies for LPP and FFA primarily target inflammation using agents like hydroxychloroquine, topical and intralesional steroids, and potential novel treatments like JAK inhibitors which show promise in targeting multiple inflammatory cytokines simultaneously. LPPg is challenging due to its disfiguring nature, especially in individuals with skin types 3-4, often exacerbated by allergens such as hair dyes. The patient response to treatment often hinges on identifying and avoiding offending agents. The presenter emphasizes the need for better understanding and research into these conditions, advocating for newer treatment approaches including systemic modifications and emerging therapies like JAK inhibitors which have shown efficacy in related conditions. Overall, the focus is on recognizing these disorders as primarily inflammatory rather than pigmentary, highlighting the critical need for ongoing research to identify disease triggers and improve therapeutic strategies.