Lichen planopilaris or Pseudopelade of Brocq: Does anyone care?

Lichen planopilaris or Pseudopelade of Brocq: Does anyone care?

Lichen Planopilaris and Pseudopelade of Brocq are Completely different Circumstances with the Similar Therapy.

Lichen plaopilaris and pseudopelade are each forms of scarring alopecia. They will look comparable – however there are numerous distinctive variations as properly too. Sufferers with lichen planopilaris usually current with scalp itching and burning and the central space of the scalp is often affected. Elevated scalp shedding is widespread within the early phases. Different areas could be affected too. Some sufferers produce other areas affected as properly together with eyebrows, and eyelashes. Some sufferers have oral, nail and vaginal lichen planus however that is current solely in a small proportion. Examination of the scalp in a affected person with LPP exhibits redness within the scalp and redness round hairs. There’s usually scaling and flaking within the scalp as properly with scaling notably seen across the hairs in energetic illness (perifollicular scale).

Pseudopelade of Brocq: A kind of main lymphocytic scarring alopecia

Pseudopelade is a scarring alopecia which additionally presents with itching and burning. The scalp is usually pink in shade though could also be surprisingly regular in look regardless of the continuing lack of hair. Sufferers with PPB usually have round or oval areas of hair loss with strikingly shut resemblance to alopecia areata. The truth is, pelade is the french phrase used for alopecia areata. Pseudopelade is completely different than LPP as a result of it usually lacks the thick perifolliuclar scale seen in LPP and sometimes has extra pores and skin atrophy. The pores and skin dips downs with tiny depressions that are known as “foot prints within the snow.”

So is it LPP or PPB?

I’ve been a part of numerous numbers of discussions through the years with sufferers, physicians, and dermatology trainees as as to if the affected person in query has lichen planoplaris of pseudopelade. There’s usually an excellent depth of dialogue across the topic. In formal dermatology rounds, doctor can debate for in depth quantities of time as if the true reply might be discovered on the finish of the spirited battle.

The truth is that PPB and LPP are distinct situations. Microarray research from 2010 confirmed this clearly. PPB isn’t just a kind of LPP. Typically talking the much less scale and redness round hairs and the extra atrophic the pores and skin is – the extra doubtless PPB might be given as a prognosis. There are histological options too that differentiate these situations – with PP usually displaying a preserved elastic fiber community whereas LPP usually exhibits a destroyed elastic fiber community. Some physicians and reserachers even really feel that PPB is so completely different from LPP that it mustn’t even be known as a scarring alopecia however somewhat needs to be known as a everlasting non scarring alopecia. That is topic to ongoing debate.

LPP or PPB: Leaving our Sufferers Confused

The energetic debate that physicians wish to have between PPB and LPP usually leaves sufferers confused. Discussions usually go one thing like this;

“I went to see Dr. X and he stated I don’t have Pseudopelade of Brocq and what I’ve is definitely LPP”

“I went to see Dr. X and he stated what I’ve is LPP”

Ending the Absurdity: Utilizing the Time period “Main Lymphocytic Scarring Alopecia”

Generally, I refuse to make use of the phrases PPB and LPP. These are normally sufferers with huge information and sufferers who’ve seen many physicians to this point. These are the sufferers the place 5 docs have stated LPP and 5 docs have stated PPB. These are the sufferers who aren’t getting higher and what to know two issues 1) What’s the correct prognosis and a pair of) what’s the greatest remedy?

Many physicians fail to recogniize that there’s not one LPP and there’s not one PPB. It’s not a matter of choosing the best reply. There are in all probability 20 completely different displays of LPP and 5-10 displays of LPP. Debating over whether or not a affected person has LPP or PPB is nice for educational functions and educating and good for understanding potential therapies. However on the finish of the day, what the affected person in entrance of us has is a scarring alopecia that’s induced partly by inflammatory cells known as lymphocytes doing issues they shouldn’t be doing.

Within the current day, the therapies for PPB and LPP are the identical!! The query that should be requested is what’s the goal of a lot in depth debate when the therapies within the current day are the identical. Topical steroids, steroid injections, doxycycline, retinoids, hydroxychloroquine, methotrexate are among the many choices. Physicians far too usually spend far too lengthy debating and one upping different colleagues with an try and current to the affected person what they assume the prognosis is that we neglect that the therapies for LPP and PPB are usually the identical.

One can argue on an on as to the related deserves of honing down the prognosis. Understanding {that a} affected person has LPP prompts one to ask about lichen planus of different areas. However nail, mucosal, vaginal signs needs to be requested of all our sufferers. Understanding {that a} affected person has LPP may immediate one to display for sure blood exams together with thyroid abnormalities. However these similar exams are nonetheless acceptable in a affected person with presumed PPB.

Conclusion

As a clinician, it’s useful to follow in a fashion that strives for accuracy. Correct prognosis are elementary to practising good drugs. However there are occasions the place we can’t all the time make correct diagnoses as a result of not all the things is all the time so clear minimize. Within the case of LPP, and PPB there are traditional displays of those illnesses and there are aytpical or non-classical displays of those illnesses. We should always attempt to acknowledge the classical circumstances and attempt in these circumstances to offer them the correct names (both LPP or PPB). Nonetheless, there are different occasions have been the efforts that go into pigeon holing our sufferers into sure illness classes solely serves to take away us farther from specializing in truly offering care to the affected person. There are dozens of variants of LPP not one. There are various variants of PPB not one.

The time period “main lymphocytic scarring alopecia” serves us properly in circumstances the place pigeon holing and efforts to pressure a prognosis simply doesn’t work.

Reference

Yu M et al. Lichen planopilaris and pseudopelade of Brocq contain distinct illness related gene expression patterns by microarray. J Dermatol Sci. 2010 Jan;57(1):27-36.

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