Turkderm-Turk Arch Dermatol Venereol. 2015; 49(4): 246-252 | DOI: 10.4274/turkderm.32767

Lichen planopilaris: Demographic, clinical and histopathological characteristics and treatment outcomes of 25 cases

Deren Özcan¹, Deniz Seçkin¹, A. Tülin Güleç¹, Özlem Özen^2
1Baþkent University Faculty of Medicine, Department of Dermatology, Ankara, Turkey
²Baþkent University Faculty of Medicine, Department of Pathology, Ankara, Turkey

Background and Design: Lichen planopilaris (LPP) is a type of cicatricial alopecia characterized by autoreactive lymphocytic destruction of the hair follicle. We aimed to evaluate the demographic, clinical and histopathological features, and treatment outcomes of patients with LPP.
Materials and Methods: Medical reports of 25 patients, who have been diagnosed with LPP according to the clinical and histopathological findings between January 2006 and June 2012, were retrospectively reviewed. The transverse and vertical sections of scalp biopsy specimens
were re-evaluated by a pathologist, and the findings were noted.
Results: Of the 25 patients, 18 were female and 7 were male, the mean age was 49.8±12.4 years. Eighteen patients had been diagnosed with classic LPP and 7 patients with frontal fibrosing alopecia (FFA). The alopecia has begun in postmenopausal period in 5 patients with
FFA. Alopecia was associated with pruritus, pain and/or burning in 19 patients. Extra-scalp involvement was observed in 11 patients. The most common clinical findings were follicular hyperkeratosis (92%), perifollicular erythema (48%), perifollicular lichenoid papules, and
positive hair-pull test (44%). Dermatoscopic examination was performed in 14 patients, and most commonly, absence of follicular openings (100%), perifollicular scales (92.9%) and perifollicular erythema (50%) were noted. The most common diagnostic histopathological findingsmwere follicular vacuolar and lichenoid degeneration (88%) and vacuolar and lichenoid interface changes (56%). Twenty-three patients who were started on treatment received topical, intramuscular and intralesional corticosteroids, topical minoxidil, oral tetracycline, cyclosporine A, and hydroxychloroquine either alone or in combination. Progression of alopecia was prevented and the symptoms and/or signs were reduced in 12 (75%) of 16 patients whose follow-up data were available.
Conclusion: LPP can be diagnosed accurately through a detailed clinical examination, dermatoscopy and histopathological examination. The symptoms and/or signs can be reduced and progression of the disease can be prevented with treatment.

Keywords: Lichen planopilaris, frontal fibrosing alopecia, histopathology, treatment, dermatoscopy

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Liken planopilaris: 25 olguda demografik, klinik ve histopatolojik özellikler ile tedavi sonuçlarý

Deren Özcan¹, Deniz Seçkin¹, A. Tülin Güleç¹, Özlem Özen^2
1Baþkent Üniversitesi Týp Fakültesi, Deri Ve Zührevi Hastalýklar Anabilim Dalý, Ankara, Türkiye
²Baþkent Üniversitesi Týp Fakültesi, Patoloji Anabilim Dalý, Ankara, Türkiye

Amaç: Liken planopilaris (LPP) kýl follikülünün otoreaktif lenfositik hasarý ile karakterli sikatrisyel bir alopesi tipidir. Burada, LPP olgularýnýn demografik, klinik ve histopatolojik özellikleri ile uygulanan tedavi sonuçlarýnýn deðerlendirilmesini amaçladýk.
Gereç ve Yöntem: Ocak 2006-Haziran 2012 tarihleri arasýnda klinik ve histopatolojik bulgulara göre LPP tanýsý almýþ 25 hastanýn týbbi kayýtlarý geriye dönük olarak incelendi. Skalp biyopsi örneklerinin transvers ve vertikal kesitleri patolog tarafýndan yeniden deðerlendirilerek bulgular kaydedildi.
Bulgular: Yirmi beþ hastanýn 18’i kadýn, 7’si erkek, ortalama yaþlarý 49,8±12,4 idi. On sekiz hasta klasik LPP ve 7 hasta frontal fibrozan alopesi (FFA) tanýsý almýþtý. FFA’lý hastalarýn 5’inde alopesi postmenopozal dönemde baþlamýþtý. Alopesi, hastalarýn 19’unda kaþýntý, aðrý ve/veya yanma ile birliktelik gösteriyordu. Hastalarýn 11’inde skalp dýþý tutulum izlendi. En sýk klinik bulgular; folliküler hiperkeratoz (%92), perifolliküler eritem (%48), perifolliküler likenoid papüller (%20) ve pozitif saç çekme testi (%44) idi. Dermatoskopik inceleme 14 hastaya yapýlmýþ ve en sýk folliküler açýklýklarda silinme (%100), perifolliküler skuam (%92,9) ve perifolliküler eritem (%50) izlenmiþti. En sýk tanýsal histopatolojik bulgular; folliküler
vakuoler ve likenoid dejenerasyon (%88) ile vakuoler ve likenoid interfaz deðiþikliði (%56) idi. Tedavi baþlanan 23 hasta topikal, intramusküler ve intralezyonel kortikosteroidler, topikal minoksidil, oral tetrasiklin, siklosporin A ve hidroksiklorokini tek baþýna veya birlikte kullanmýþtý. Ýzlem bilgileri olan 16 hastanýn 12’sinde (%75) alopesinin ilerlemesi engellenmiþ ve semptom ve/veya bulgular gerilemiþti.
Sonuç: Ayrýntýlý bir klinik muayene, dermatoskopi ve histopatolojik deðerlendirme ile LPP’nin kesin tanýsýnýn konmasý mümkündür. Tedavi ile semptomlar ve/veya bulgular azaltýlabilir ve hastalýðýn ilerlemesi önlenebilir.

Anahtar Kelimeler: Liken planopilaris, frontal fibrozan alopesi, histopatoloji, tedavi, dermatoskopi

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