Management of classic lichen planopilaris: The EADV task force on hair diseases position statement

Abstract

Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia primarily affecting the vertex or parietal scalp. This immune-mediated condition involves mainly CD8⁺ cytotoxic T cells targeting follicular antigens, causing inflammation and permanent damage to hair follicles. Early diagnosis and prompt intervention are then essential to minimize hair loss and prevent further disease progression. Managing LPP is challenging due to the absence of curative treatments and the unpredictable nature of the disease and treatment responses. This position statement summarizes the results of an extensive literature review analysed through the collective expertise of the European Academy of Dermatology and Venereology (EADV) Task Force on Hair Diseases. Treatment strategies for LPP encompass a range of topical, systemic, and interventional therapies. First-line treatments often include potent topical and intralesional steroids, which can be used alone or in combination with other therapies. For patients with moderate to severe disease, resistance to topical/intralesional steroids, or a progressive disease course, systemic therapy or a combination approach should be considered, tailored to disease activity, comorbidities, and patient preferences. While there is no known cure for LPP, randomized controlled trials are limited and no head-to-head treatment comparisons have been conducted to date, these recommendations should be personalized for each patient.