Lichen planopilaris is an inflammatory condition in which the immune system attacks hair follicles and can destroy them for good. It mostly affects the top and sides of the scalp. Unlike pattern hair loss, it often itches, burns or hurts, and the scalp around the hairs can look red and scaly. Because the damage is permanent, an early diagnosis matters more here than for almost any other kind of hair loss.
There is no cure, but treatment aims to stop it spreading and to ease the symptoms. The record you keep, photos and symptom notes, is also how you and your dermatologist judge whether it is still active.
TL;DR
- Lichen planopilaris is a scarring alopecia: the inflammation can destroy follicles permanently.
- It mainly affects the crown and the sides of the scalp.
- Itch, burning, pain, redness and scaling around hairs are typical. Pattern hair loss has none of these.
- Diagnosis needs a dermatologist, usually with a magnified scalp exam and sometimes a biopsy.
- There is no cure. Early treatment aims to stop the spread and keep the hair you have.
Important
This article is educational and not medical advice. If you are worried about sudden shedding, scalp symptoms, or side effects, talk to a licensed clinician.
What it is
A 2026 position statement from the European Academy of Dermatology and Venereology describes lichen planopilaris as a primary scarring alopecia that mainly affects the vertex, the top of the head, and the sides of the scalp. Immune cells target the hair follicles, causing inflammation and permanent damage, so early diagnosis and prompt treatment are essential to limit hair loss (Seyed Jafari and colleagues, 2026). Lichen planus, its relative on the skin, can also cause bald patches on the scalp, according to the NHS (NHS: lichen planus).
How it differs from pattern hair loss
- Symptoms: the EADV statement lists itch, pain and burning among the symptoms used to rate how active the disease is. Pattern hair loss does not hurt.
- The skin around hairs: redness and scaling around each hair are signs of activity. Pattern loss leaves the scalp looking normal.
- Shiny patches: in later, inactive stages, shiny white areas can appear on the scalp.
- Pattern: lichen planopilaris spreads in patches, often on the crown and sides. Pattern loss follows the hairline, temples and crown evenly.
Under a dermatoscope, a magnifying scalp camera, a 2025 systematic review found that casts around the base of hairs and redness around the follicles suggest early lichen planopilaris, while shiny white areas appear once it is inactive (Gowda and colleagues, 2025). A dermatologist reads these signs; a home photo is not a substitute. For what a scalp exam shows, see what a scalp exam reveals.
The frontal variant
Frontal fibrosing alopecia, which moves the front hairline back, is closely related, and specialists still debate whether the two are one condition or two (Gowda and colleagues, 2025). See frontal fibrosing alopecia signs.
Treatment, in brief
The EADV statement says there is no cure and that responses to treatment are hard to predict. Its treatment goals are to stop the bald areas from spreading and to relieve symptoms. Options range from treatments applied to or injected into the scalp to medicines taken by mouth, chosen by a dermatologist according to how active the disease is (Seyed Jafari and colleagues, 2026). Hair lost to scarring does not regrow, which is why timing matters.
What to record
- Symptom scores: itch, burning and pain, each scored the same simple way every week.
- Patch photos: each patch from a fixed distance, in the same light, with a coin or ruler for scale.
- Edges: a close photo of the border of each patch, where activity usually shows.
- Treatment dates: what your dermatologist prescribed and when.
- Spread: any new patch, with the date you first noticed it.
Matched photos make a slow spread visible. See comparing hair photos without bias.
When to see a dermatologist
Book soon if hair loss comes with itch, burning, pain, redness or scaling around the hairs, or if you see shiny smooth patches. Ask whether a biopsy is needed. Do not wait for months of photos first: with a scarring condition, the time lost is hair lost. See when to see a dermatologist for hair loss.
Next step
If your scalp itches or burns where the hair is thinning, photograph the area today and book a dermatologist. Bring the photos and a note of when the symptoms began.
Related reading
- Frontal fibrosing alopecia signs
- Central centrifugal cicatricial alopecia signs
- Trichoscopy: what a scalp exam reveals
Sources: Seyed Jafari et al. 2026, Journal of the European Academy of Dermatology and Venereology; Gowda et al. 2025, Dermatology Practical and Conceptual; NHS: lichen planus.
