Lichen Nitidus: A Classic Presentation in a 4-Year Old

An otherwise healthy 34-year-old woman was concerned because of the abrupt onset of rapid hair loss, accompanied by scaling of the underlying skin (A). The disorder had begun 3 months earlier, and the right parietal and temporal areas were now red and swollen and had adherent scale. An antinuclear antigen titer was negative. Biopsy revealed changes consistent with lichen planus of the scalp, also known as lichen planopilaris and lichen planus follicularis.

Lending credence to this diagnosis, writes Dr Reynold C. Wong of Sacramento, Calif, was the presence of Wickham's striae (fine, pale lines) on the patient's buccal mucosa and lower lips. Intralesional injections of corticosteroids curtailed the hair loss, but regrowth did not occur.

Scalp manifestations occur in only a small proportion of cases of lichen planus, generally in patients between ages 30 and 60, and considerably more often in women. Rapid extension of the condition during the first year, as seen in this patient, is very uncommon.

Drs Eric J. Lewis and Charles E. Crutchfield III, of Minneapolis point out that in addition to perifollicular scaling, spinous papules, and residual scarring, the presence of several hair shafts exiting a single ostium (polytrichia) is characteristic of lichen planopilaris (B).