What is the first treatment for lichen planopilaris?

Lichen planopilaris is a scarring form of hair loss in which inflammation surrounds and damages scalp follicles. It may cause itching, burning, tenderness, scaling or gradually thinner patches. Once a follicle is scarred, it may not produce hair again, so controlling active inflammation is the central aim.

An intralesional steroid injection places medicine directly into selected inflamed scalp areas. A dermatologist chooses the sites and amount according to examination findings. This approach can be useful when activity is localised; broader or more persistent inflammation may need treatment affecting a larger area.

Book a dermatology assessment if you notice expanding thinning, scalp symptoms or smooth patches with fewer visible follicle openings. The clinician may examine the scalp closely and sometimes recommend a biopsy before settling on a treatment plan.

Do not scratch, tug or apply irritating hair products to tender areas. Tell the clinician about medicines, infections, diabetes or previous reactions to steroid treatment. If injections are not enough or the affected area is extensive, oral corticosteroid treatment may be discussed for a carefully selected period.

Seek prompt review when hair loss is spreading, pain or burning is increasing, crusting develops, or the scalp becomes markedly red or swollen. Earlier review helps distinguish active inflammation from other causes of hair loss and supports timely treatment decisions.

Ask how scalp activity will be monitored, whether an injection is suitable for each area, what side effects to watch for, and when oral corticosteroid treatment would be considered.