In short
- Scarring — lost hair does not regrow.
- Signs: burning, itching, perifollicular scale.
- Trichoscopy diagnostic; biopsy confirms.
- Treatment aims to arrest, not reverse.
Lichen planopilaris is a lymphocytic scarring alopecia — the immune system attacks the hair follicle stem cells, and once destroyed, they don't come back. That makes it the most time-critical hair-loss diagnosis in trichology.
Recognising LPP
- Burning or painful scalp — often the first symptom
- Perifollicular erythema and fine scale (needs trichoscopy)
- Loss of follicular openings in affected areas — 'smooth' scalp
- Frontal or vertex accentuation
- Sometimes coexists with oral lichen planus
The London pathway
Trichologist → dermatologist referral (specialist hair clinic — St John's Institute, Royal London, or private). Scalp biopsy confirms diagnosis. Treatment includes potent topical steroids, intralesional steroid injections, hydroxychloroquine, sometimes methotrexate or ciclosporin. Response is measured in months.
Living with LPP
Trichologists monitor every 3–6 months. Photography and hair pull tests measure activity. When quiet, treatment can be tapered. Camouflage (topical fibres, medical wigs) helps aesthetically.
Every month LPP is active is hair you don't get back. Act fast, monitor forever.
Frequently asked
Common questions
Is LPP genetic?+
Weak genetic component; environmental triggers unclear. More common in perimenopausal women.
Will hair transplant work after LPP burns out?+
Only if the disease is inactive for 2+ years. Even then, results are unpredictable.
What's the difference between LPP and FFA?+
FFA is a subtype of LPP with frontal hairline pattern. Same disease family.
Keep reading
Related, trichologist-reviewed
Scalp
Frontal fibrosing alopecia in London — the rising cause of hairline loss in women
Frontal fibrosing alopecia now accounts for more than 1 in 5 hairline-loss consultations in London women over 50. Speed of diagnosis decides speed of arrest.
Read
Hair loss
Alopecia areata in London: the 2026 treatment landscape after JAK inhibitors
The alopecia areata conversation changed permanently the day JAK inhibitors were licensed. Here is what that means for London patients in 2026 — and what the treatment ladder still looks like below them.
Read
Scalp
CCCA in London — the scarring alopecia most common in Afro-textured hair
CCCA is the most common scarring alopecia in Black women. Early treatment saves follicles. Late treatment saves what's left.
Read