When is oral corticosteroid treatment recommended for lichen planopilaris?

Lichen planopilaris is an inflammatory form of scarring hair loss that targets the follicles. The aim of oral corticosteroids is to calm inflammation quickly enough to limit further follicle injury; they cannot reliably restore a follicle that has already been replaced by scar tissue. A dermatologist may weigh scalp redness, burning, tenderness, scaling around hairs, shedding, and the speed of change when deciding whether tablets are appropriate.

Arrange a dermatology assessment if scalp symptoms or hair loss are progressing. Your clinician may examine the scalp closely and may discuss a biopsy or other treatment alongside a short, supervised corticosteroid course. Share your medicines and history of diabetes, high blood pressure, stomach problems, mood symptoms, infections, or bone concerns. Do not start, stop, or change the dose yourself; oral corticosteroids need a clinician-guided plan.

Seek prompt medical advice for rapidly worsening scalp pain, marked swelling, pus, fever, or sudden expansion of hair loss. These findings can signal infection or active inflammation needing reassessment. Seek urgent help for severe weakness, breathing difficulty, confusion, or a serious allergic reaction while taking a prescribed medicine.

Ask whether your scalp shows active inflammation, what outcome the course is intended to achieve, how tapering will work, and which local or steroid-sparing options could help maintain control.