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53 years
The bold spots on my face and on my hair line are red and shiny and look like they are burned. my biopsy showed it was lichen planopilaris but later on I was diagnosed with lupus. would the hair ever
Aug 15, 2014

Dr. Rania Mousa General Medicine
From your description both conditions a lichen planopilaris or a discoid lupus erythematous might be with this description of symptoms , They even look alike but lupus more generalized and appear in more than one area of skin in the body especially the areas exposed to sun.

Unfortunately ,lesions of hair loss may be permanent in both cases and treatment is to lower the rate of hair loss .

Lichen planopilaris (LPP) is an uncommon inflammatory scalp disorder that is clinically characterized by perifollicular erythema, follicular hyperkeratosis, and permanent hair loss

It is devided in to three types your type might be the frontal fibrosing alopecia

Frontal fibrosing alopecia was initially thought of as occurring only in postmenopausal women, but was recently also described in a premenopausal woman as well as a man. It is characterized by a progressive recession of the frontal hairline. Initially there is follicular hyperkeratosis with perifollicular erythema at the hairline margin

Classic lichen planopilaris shows great clinical and histological overlap with discoid lupus erythematosus of the scalp. It manifests most commonly with hyperkeratotic follicular papules and spines surrounded by a mild erythema

Like discoid lupus erythematosus of the scalp, classic lichen planopilaris represents a lymphocyte-mediated interface of dermatitis and folliculitis

The main differential diagnosis is with discoid lupus erythematosus of the scalp, with which it can have considerable overlap. A combined clinicopathologic approach should be sought. In difficult cases the most reliable distinguishing features in lichen planopilaris are immunofluorescent cytoid bodies in close proximity to the follicular epithelium. In discoid lupus erythematosus a linear, granular deposition of IgG and C3 is seen at the dermal–epidermal junction and at the junction of the dermis and follicular epithelium as well, which is not typically present in lichen planopilaris.
however if you are diagnosed with lupus (discoid lupus erythematous) then you are more commonly may suffer from lichen planus or lichen planopilaris ,meaning that having lichen planilaris are more common in patients with discoid erythematous lupus

both share similar dermatologic appearance with difference in areas sometimes ,they also may share a similar treatment plan which is good .
both have the auto immune process and make the presentation progressive and bad with time especially when treatment is not begun at early stages

>>Treatment should be sought and provided early as no treatment recovers hairs that have been lost and replaced by scarring. The aim of treatment is to slow progression of the disease and relieve symptoms. Hair loss may continue, although at a slower rate.

Treatment options include in both conditions mainly :
corticosteroids ,potent topical, intralesional, oral
topical tacrolimus
different treatments may be held due to case


>First diagnosis of lichen planopilaris clinically and with a scalp biopsy or insure of the other diagnose is important for proper treatment

>Severity of symptoms, extent of hair loss, and presence of disease activity are documented at each visit, approximately every 3 months.

>Oral hydroxychloroquine (usually 200 mg twice daily) is started after appropriate laboratory tests and eye check if the patient is symptomatic, has progressive hair loss or signs of active disease.

>Intralesional and potent topical corticosteroids may also be used.

>After 2-4 months, hydroxychloroquine is changed to ciclosporin if symptoms continue, extent of hair loss progresses, or there are clinical signs of disease activity. Ciclosporin is used according to the ciclosporin consensus guidelines.

>Camouflage with careful hair styling and hair colouring. Hair pieces may be required for areas of permanent hair loss.

>Surgery such as scalp reduction and hair transplantation has been used for end-stage disease with large areas of scarring, but is not always successful.
Dr. Zakia Dimassi Pediatrics
As I have mentioned in my previous answer, being on Femara (letrozole), an aromatase inhibitor, is by its own right a risk for hair loss, mainly a risk for an entity known as “androgenic alopecia”, where hair loss occurs on the crown (the front hair line). This is because it reduces the level of estrogen in the blood by blocking the transformation of testosterone into estrogen.
On the other hand, this same drug has been reported to induce cutaneous lupus (cutaneous means lupus that is restricted to the skin and usually does not involve other organs as in the case of systemic lupus)
Aromatase inhibitors have been reported to induce cutaneous adverse reactions, cutaneous lupus ios one of the described skin side effects of this drug.
Lupus belongs to a category of diseases known as autoimmune diseases, which usually involve more than one system in the body.
These lesions are characterized by thickened, red scaly patches that often involve the cheeks, nose and ears. These lesions may also involve the v of the neck, upper back and dorsum of hands. No itching or pain is described. Once these lesions resolve, they may leave dark or light pigmentation as well as atrophy (thinning of the skin). If these lesions involve the scalp or the hair follicles, areas of hair loss may be seen; hair loss may be irreversible if the hair follicle is severely damaged.
The exact mechanism underlying cutaneous vasculitis induced by aromatase inhibitors remains not well understood. It has been suggested that the alteration in the hormone levels produced by aromatase inhibitors may trigger autoimmunity. Another possible explanation is an idiosyncratic drug reaction, which means that your body, for some unknown reason, reacts to Femara by attacking skin cells and hair follicles. Also, some scientists proposed that this is due to a decrease in the number and function of HER2 receptors, these are the receptors found on the breast tissue and that are targeted by Femara (Femara is only used in HER2 positive cases of breast cancer).