Health condition
Lichen planopilaris
Lichen planopilaris is lichen planus of the scalp: inflammation destroys hair follicles and replaces them with scar tissue, so hair loss is permanent once follicles are gone - which makes early diagnosis and treatment genuinely urgent.
Why trust this guide
- 01
Editorial team
Written by our editorial team from the UK sources listed on each page.
- 02
Sourced from guidance
Checked against current NHS and UK specialist society guidance at the time of review.
- 03
Current for 2026
Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.
Key facts
The essentials at a glance.
The symptoms to recognise, when to seek help, which specialist to see, and what treatment usually involves.
-
Patchy scalp hair loss with redness and scale hugging the base of remaining hairs, often with itch, burning or tenderness
-
It is a scarring (cicatricial) alopecia - follicles that are destroyed do not regrow
-
Frontal fibrosing alopecia, a variant, causes a slowly receding hairline band and eyebrow loss, mostly in post-menopausal women
-
Scalp biopsy confirms the diagnosis; anti-inflammatory treatment aims to halt progression and protect remaining hair
Understanding the condition
What it is and what happens next.
What causes it, how it is diagnosed, and the treatment routes available in the UK.
What it is and how it feels
In lichen planopilaris the immune attack focuses on the stem-cell region of the hair follicle, so each flare quietly converts working follicles into small tracts of scar. People typically notice increased shedding, tender or burning patches, and smooth shiny areas where follicular openings have disappeared - a key sign distinguishing it from non-scarring alopecia areata.
Diagnosis and treatment routes
A dermatologist uses dermoscopy (trichoscopy) and a scalp biopsy from an active margin to confirm the diagnosis, then treats to switch off inflammation: super-potent topical or intralesional steroids first, with hydroxychloroquine, tetracyclines, or agents such as pioglitazone and low-dose naltrexone for progressive disease. The realistic goal is stabilisation, which is why weeks matter more here than in most hair conditions. In much of the UK, a routine NHS referral to the relevant specialist clinic can take several months, whereas an initial appointment with a private consultant is typically available within around two weeks.
Seeing a specialist
Who to see, and how quickly you can be seen.
The specialist for this condition is usually a consultant dermatologist. Your GP can refer you on the NHS, or you can arrange a private consultation directly.
A quiet reminder
This guide is for information, not medical advice.
Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any of the emergency symptoms described above.
Frequently asked
Common questions about Lichen planopilaris.
Quick, plain-English answers to what people ask us most.
-
What is lichen planopilaris?
Lichen planopilaris is an inflammatory condition affecting hair follicles on the scalp, leading to progressive, scarring hair loss. It's considered a variant of lichen planus specifically targeting the scalp's hair follicles.
-
What causes lichen planopilaris?
It's an autoimmune condition where the immune system mistakenly attacks hair follicles, though the exact trigger for this isn't fully understood. It's not caused by an infection or by anything you've done, and can affect anyone, though it's more common in adults.
-
What are the symptoms of lichen planopilaris?
Symptoms include itching, burning or tenderness of the scalp, redness around hair follicles, and progressive patchy hair loss that, unlike some other forms of hair loss, is permanent due to scarring of the follicles. Early treatment aims to halt progression before extensive scarring occurs.
-
Is lichen planopilaris dangerous?
It's not dangerous to general health, but it causes permanent, scarring hair loss if not treated early, which can be distressing. Prompt diagnosis and treatment can significantly slow or halt progression, preserving more hair.
-
Is lichen planopilaris hereditary?
There's no strong evidence it's directly inherited, though autoimmune conditions in general can have some genetic predisposition that runs in families. Most cases occur without a clear family history of the specific condition.
-
Can lichen planopilaris be cured?
There's no guaranteed cure, and any hair loss that has already caused scarring is permanent, but treatment can effectively halt or slow further progression in many cases. Early treatment gives the best chance of preserving existing hair.
-
How is lichen planopilaris treated?
Treatment typically involves topical or injected corticosteroids to reduce inflammation, and sometimes oral immune-modulating medications for more widespread or resistant disease. Regular dermatology follow-up helps monitor disease activity and adjust treatment as needed.
-
How long does treatment for lichen planopilaris take to work?
Response to treatment can take several months to assess, as the goal is to halt further hair loss rather than necessarily regrow already-scarred areas. Your dermatologist will monitor disease activity through regular examination to judge treatment effectiveness.
-
Lichen planopilaris vs alopecia areata — what's the difference?
Lichen planopilaris causes scarring, permanent hair loss with visible inflammation around follicles, while alopecia areata causes non-scarring hair loss where follicles remain intact and can potentially regrow hair. A scalp biopsy can help distinguish between these different causes of hair loss.
-
When should I see a specialist about lichen planopilaris, and how quickly can I be seen privately?
Progressive patchy hair loss with scalp itching or tenderness should be assessed by a dermatologist promptly, as early treatment offers the best chance of preserving hair. Private dermatology consultations can typically be arranged within about two weeks, considerably faster than standard NHS waiting times.