8 yr old boy presented with localised hairloss for 3 weeks and pigmented raised lesion over the forehead for 2 weeks.
Not associated with itching or pain
No h/o similar lesion anywhere else
No h/o fever in the recent past.
No h/o any drug intake or topical application
No h/o any liver disease
No h/o any ulcer over the site.
No h/o any thyroid diseases/vitiligo.
No similar history in the past
A single linear violaceous plaque of size 10*3 cm starting from the forehead extending to the scalp with peripherally raised margins(over the forehead) with central atrophy and diffuse alopecia.
A single localised patch of alopecia of size 2*2 cm present over the parietal region
Nails: Coarse pits present over bilateral ring finger. Toe nails are normal
Palms and soles:normal
Dermascopy: peripilar cast present
Diagnosis: Lichen planopilaris
1.Evolving en coupe de sabre
Lichen planopilaris (follicular lichen planus)
-Clinical variant of Lichen planus.
-May be associated with alopecia of the trunk.
-Follicular lesions in the scalp may be associated with scaling and may lead to scarring alopecia
-Can present in 3 distinct variants in the scalp -lichen planopilaris, frontal fibrosing alopecia, and Gram-Little- PiccardiLassueur syndrome.
–Graham Little–Piccardi–Lassueur syndrome : triad of multifocal scalp cicatricial alopecia, non‐scarring alopecia of the axillae and/or groin, and keratotic lichenoid follicular papules.
–Frontal fibrosing alopecia: considered as a variant of Lichenplanopilaris, that affects elderly women, involves the scalp and eyebrows.
-An absence of arrector pili muscles and sebaceous glands
-Perivascular and perifollicular lymphocytic infiltrate in the reticular dermis
– Mucinous perifollicular fibroplasia within the upper dermis with an absence of interfollicular mucin,
– Superficial perifollicular wedge‐shaped scarring
– Differential diagnosis:
Lupus erythematosus (scalp)