Trichoscopy of Lichen Planopilaris in Black Scalp: A Literature Review

Background: Lichen planopilaris (LPP) manifests as uni or multifocal patches of scarring alopecia across the scalp. Its symptoms include pruritus, trichodynia, and burning. Trichoscopy is a critical tool for early disease detection. In African descendants, LPP poses additional diagnostic challenges, given the black scalp peculiarities. These specific features include lower hair density, slower growth, and structural differences, compared to Caucasians. Moreover, the healthy black scalp may show distinctive features such as a honeycomb-pigmented network and sparse pinpoint white dots.

Summary: In individuals of African descent, the most prevalent scarring alopecia is Central Centrifugal Cicatricial Alopecia, an important differential diagnosis for LPP in this population. LPP trichoscopy in the black scalp reveals unique features such as perifollicular erythema in the early stages, which often manifests as hyperpigmentation. This study aimed to review the literature on trichoscopy findings in LPP on black scalp categorizing them into distinct stages and highlighting their unique yet understudied characteristics.

Key Messages: Despite not being as prevalent as nonscarring alopecias and not so frequent in the black scalp, LPP's aesthetic and devastating psychosocial impact raise concerns. Therefore, early recognition is paramount to halt the progress of LPP, mitigate its psychosocial impact, and prevent misdiagnosis.