What is your treatment algorithm for treating patients with lichen planopilaris?

LPP can be localized and smoldering or widespread like a wildfire. All patients are treated with a potent topical steroid solution. For some that is all that is required. For those with severe or active disease I will start an oral agent such as doxycycline or hydroxychloroquine and consider intralesional steroids. A brief course of systemic steroids can be very helpful for rapidly progressing disease. Alternate therapies such as 5 alpha reductase inhibitors are increasingly being used due to their excellent safety profile and tolerability. The emotional affects of hair loss are always addressed, and camouflage agents or sometimes prosthetics are discussed and/or demonstrated, and on line resources (Scarring Alopecia Foundation) provided.