The Paper Sign Test - Assessment, Evaluation, and Diagnosis Method for Reactivated Lichen Planopilaris by Physician and Patient.

Background: Lichen planopilaris (LPP) is an inflammatory disease that results in destruction of the hair follicle and replaces it with patchy permanent scarring alopecia; after stabilizing by treatment, reactivation is common and may be insidious. During remission, various methods are available for realizing that the disease is activated or not, but neither of them is practical for patients.

Objectives: This study aims to evaluate the paper sign test for reactivated LPP by physician and patient.

Patients and methods: In a prospective study, during 2 years, 83 treated LPP patients have been divided into two groups of 41 and 42. Group 1 instructed for paper sign test which is to comb their hair over a white paper sheet to catch any fallen hairs, then turn the paper upside down, if all collected hair on paper completely separated, test is considered negative, if even one hair hangs onto the paper, the test is considered positive. Group 2 trained for clinical symptoms (hair shedding, scaling, itching, pain, tenderness, and burning).

Results: From the first group, 13 patients had positive paper sign, and from the second group, 35 patients had clinical symptoms; after clinical examination and biopsy, 13 from Group 1 and 17 from Group 2 were confirmed to have reactivated disease. Patients in the first group who had been trained for paper sign test became aware of relapse sooner and came earlier for the evaluation of disease.

Conclusion: Paper sign test is a reliable, noninvasive, and practical test for early detection of reactivated LPP by patients during remission period.