Lichen planopilaris (LPP) is a primary scarring alopecia (cicatricial alopecia). That means inflammation targets the hair follicle and can replace it with scar tissue. The goal of care is to stop activity early to prevent permanent loss.
Frontal fibrosing alopecia (FFA) is widely considered a patterned variant of LPP that mainly affects the frontal hairline and often the eyebrows.
Medical note: This article is for general education and does not provide personal medical advice. For the full roadmap, start here: Hair Loss (Complete Guide).
Quick navigation
- What it is (plain English)
- What it usually looks like (LPP vs FFA)
- Symptoms you may feel
- Trichoscopy clues (why dermoscopy helps)
- How it’s diagnosed (and why biopsy may matter)
- Treatment overview (what clinicians may use)
- What to do now (safe steps)
- Prognosis (realistic expectations)
- When to see a doctor (red flags)
- FAQ
- References
What is lichen planopilaris?
LPP is an inflammatory condition that targets hair follicles, most commonly on the scalp. Over time, inflamed follicles can be destroyed and replaced by scar tissue—leading to permanent hair loss in that area.
On our site, this belongs under: Scarring Alopecia (Hub) → Primary Scarring Alopecia.
Where does frontal fibrosing alopecia (FFA) fit?
FFA is a patterned scarring alopecia most noticeable along the front hairline (and often the eyebrows). Many experts consider it a clinical variant of LPP because biopsy patterns are similar.
What it usually looks like (LPP vs FFA)
LPP (classic pattern)
- Patchy areas of hair loss, often on the crown/vertex
- Perifollicular scale (scale around individual hairs) at the “active edge”
- Perifollicular redness and sometimes a “tight” or shiny look in more advanced zones
- Loss of follicle openings in scarred areas (a key scarring clue)
- Sometimes “lonely hairs” (a few remaining terminal hairs in a scarred patch)
FFA (patterned hairline variant)
- Receding frontal/temporal hairline that looks smooth and band-like
- Eyebrow thinning/loss is common
- Perifollicular redness/scale at the hairline in active disease
Symptoms you may feel
LPP/FFA are often symptomatic (unlike many non-scarring causes). Common symptoms include:
- Itch
- Burning or stinging
- Tenderness or pain (especially in active areas)
Trichoscopy clues (why dermoscopy helps)
Trichoscopy (scalp dermoscopy) helps identify activity and supports the diagnosis. Common findings clinicians look for include:
- Perifollicular scaling / casts
- Perifollicular erythema (redness around follicles)
- Reduced/absent follicle openings in scarred areas
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How it’s diagnosed (and why biopsy may matter)
Diagnosis typically combines history, clinical pattern, and trichoscopy. Because several scarring conditions can look similar, clinicians may recommend a scalp biopsy to confirm the diagnosis and guide treatment.
Treatment overview (what clinicians may use)
Goal: reduce inflammation and slow/stop progression. Regrowth is limited in fully scarred areas, so early care matters.
Common treatment “buckets” your clinician may consider (depending on severity and risks):
- Anti-inflammatory topicals: potent topical corticosteroids; sometimes steroid-sparing topicals
- Targeted injections: intralesional corticosteroids in active zones
- Systemic options: medications such as hydroxychloroquine or other anti-inflammatory/immunomodulating agents may be used in more extensive/active disease
- FFA-specific additions: some clinicians use additional agents for patterned hairline disease (case-dependent)
See the general framework: Treatment Overview.
What to do now (safe steps)
- Don’t wait if symptoms are active: burning/tenderness + widening patches → book evaluation.
- Document progression: photos every 2–4 weeks (same lighting).
- Be gentle with hair care: avoid tight traction, harsh chemicals, aggressive heat while the scalp is inflamed.
- Avoid self-treating with random regrowth products first: in scarring disease, controlling inflammation is priority.
Prognosis (realistic expectations)
Many people can achieve stabilization once inflammation is controlled, but results vary. Earlier diagnosis generally offers the best chance to preserve hair.
Read: Prognosis & Expectations.
When to see a doctor (red flags)
- Burning, pain, or marked tenderness
- Rapid expansion over weeks
- Pus, crusting, or severe inflammation
- Shiny smooth patches with reduced follicle openings
Read: When to See a Doctor.
FAQ
Is regrowth possible?
Hair may regrow in areas that are inflamed but not fully scarred. In fully scarred zones (no follicle openings), regrowth is limited. That’s why early control matters.
Do I need a biopsy?
Not always, but biopsy is commonly used in scarring alopecia to confirm the diagnosis and guide treatment choice.
Is FFA the same as LPP?
FFA is generally considered a patterned variant within the LPP spectrum. The distribution differs (front hairline/eyebrows), but the scarring mechanism is similar.
Can hair transplant help?
In selected cases, transplantation may be considered only after the disease is inactive/stable for a significant period and under specialist guidance.
References (trusted medical sources)
- DermNet: Lichen Planopilaris
- DermNet: Frontal Fibrosing Alopecia
- British Association of Dermatologists (BAD): Lichen Planopilaris leaflet
- BAD: Frontal Fibrosing Alopecia leaflet
- NCBI Bookshelf (StatPearls): Frontal Fibrosing Alopecia
- Review (2022): LPP & FFA diagnostic/treatment aspects (PDF)
Last updated: February 03, 2026.
