Lichen planopilaris

QUESTION 43

A 54-year-old woman presents with progressive hair loss on the crown and vertex of the scalp. She states that this has been ongoing for the past 2–3 years. She notes occasional scalp tenderness, burning and pruritus. On physical examination, there is loss of follicular ostia and increased interfollicular distance on the parietal scalp. There is evidence of perifollicular scaling and inflammation (43a). Two 4-mm punch biopsies were performed, which demonstrated a dense perifollicular lymphocytic infiltrate with wedge-shaped hypergranulosis and perifollicular fibrosis.