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Because alopecia in LPP is permanent and can lead to scarring, early recognition and treatment are essential to limit disease progression and preserve remaining scalp hair.",{"@graph":14,"@context":65},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/moth-eaten-pattern-of-alopecia-in-lichen-planopilaris/450097/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/moth-eaten-pattern-of-alopecia-in-lichen-planopilaris/450097.png","ImageObject",300,407,{"name":42,"@type":43},"Olivia Brown","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",13,{"@type":57,"mainEntity":58},"FAQPage",[59],{"name":60,"@type":61,"acceptedAnswer":62},"What treatment was started after baseline evaluation?","Question",{"text":63,"@type":64},"The patient was started on 15 mg weekly oral methotrexate after baseline evaluation. Because steroids may worsen hyperglycemia and hydroxychloroquine can induce hypoglycemia in patients receiving insulin, methotrexate was preferred as the systemic agent in this case.","Answer","https://schema.org",{"og:url":32,"og:type":67,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":69,"canonical":32},"index,follow",{"doc_id":71,"site_id":7},450097,1790953014,{"code":4,"msg":74,"data":75},"success",[76,80,84,88,93,98,102,107,112,115,119],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":77,"show_sort_weight":78,"slug":79},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":81,"show_sort_weight":82,"slug":83},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Exam",70,"exam",{"id":89,"doc_module":4,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},5,"Comic",60,"comic",{"id":94,"doc_module":4,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},6,"Technology",50,"technology",{"id":99,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":100,"slug":101},7,40,"healthcare",{"id":103,"doc_module":4,"doc_module_name":25,"category_name":104,"show_sort_weight":105,"slug":106},8,"Research & Report",30,"research-report",{"id":108,"doc_module":4,"doc_module_name":25,"category_name":109,"show_sort_weight":110,"slug":111},9,"Religion & Spirituality",20,"religion-spirituality",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":113,"show_sort_weight":110,"slug":114},"World Cup","world-cup",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":116,"slug":118},10,"Lifestyle","lifestyle",{"id":120,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":89,"slug":122},19,"General","general",{"code":4,"msg":74,"data":124},{"doc_id":71,"user_id":125,"nickname":42,"user_avatar":126,"doc_module":4,"category_id":99,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":127,"file_id":128,"file_url":129,"file_type":130,"file_size":131,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":132,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":133,"faqs":134,"seo_title":135,"seo_description":12,"update_tm":136,"read_time":103,"preview_page_count":4},16904993612988,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Clinical Case Reports  \nCASE IMAGE  OPEN ACCESS   \nMoth-Eaten Pattern of Alopecia in Lichen Planopilaris  \nSunil Jaiswal  | Shraddha Uprety | Pratichya Thapa | Prakriti Lamichhane Department of Dermatology, Chitwan Medical College, Bharatpur, Nepal  \nCorrespondence: Sunil Jaiswal ([sj138540b2@gmail.com](sj138540b2@gmail.com))  \nReceived: 13 September 2025 | Revised: 29 November 2025 | Accepted: 21 December 2025  \nKeywords: histopathology | lichen planopilaris | moth-eaten alopecia | trichoscopy  \n\n| ABSTRACT\u003Cbr>Moth-eaten pattern of alopecia can be seen in various dermatological conditions, including lichen planopilaris (LPP) . Clinical, trichoscopic, and histopathology correlation can give a clue to the etiology of moth-eaten pattern of alopecia. Since alopecia in LPP is permanent, early recognition and treatment are necessary to prevent progression of scarring. |  |\n| --- | --- |\n| A 18 years old male patient, a student, known case of Type I Diabetes Mellitus, presented with gradually progressive, multiple small ill-defined atrophic patches of hair loss on the parietal region of scalp for 1 year (Figure 1) . Patient denied any history of genital ulcer and VDRL in titer/TPHA was nonreactive. Trichoscopic and histopathological images (10× and 40×) are shown in Figures 2–5. What is your diagnosis?\u003Cbr>A. Rapidly progressive alopecia areata\u003Cbr>B. Syphilitic alopecia\u003Cbr>C. Pseudopelade of brocq\u003Cbr>D. lichen planopilaris\u003Cbr>E. Discoid lupus erythematosus\u003Cbr>1 | Discussion\u003Cbr>The patient presented with multiple ill-defined alopecic patches which gradually progressed in number giving the scalp hair a moth-eaten appearance (Figure 1) . Trichoscopy revealed yellowish-orange areas lacking hair follicles, violaceous areas, and peritubular scaling (Figure 2) . Histopathological examination of tissue revealed follicular plugging, follicular basal vacuolization, band-like lichenoid lymphocytic infiltrate around | \u003Cbr>FIGURE 1 | Clinical image. Multiple small ill-defined patches of hair loss on the parietal region of scalp. |\n| This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.\u003Cbr>© 2026 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd. |  |\n\nClinical Case Reports, 2026; 14:e71817 1 of 3  \n[https://doi.org/10.1002/ccr3.71817](https://doi.org/10.1002/ccr3.71817)  \nFIGURE 2 | Trichoscopic image. Dermoscopy shows yellowishorange areas lacking hair follicles, violaceous areas and peritubular casts.  \nFIGURE 3 | Histopathological image (10×) . Histopathology shows follicular plugging, interface dermatitis, and band like lichenoid lymphocytic infiltrate around the infundibulo-isthmic region of hair follicle.  \nthe infundibulo-isthmic region of the hair follicle, and melanin incontinence (Figures 3–5) . Syphilis was excluded through negative serology. Tinea capitis was not considered due to lack of scalp scaling or inflammatory signs and negative KOH examination. Trichotillomania was ruled out based on the absence of hair-pulling history and lack of broken hairs at different lengths or trichoptilosis on dermoscopy. Alopecia areata was also excluded as yellow dots, exclamation hairs, and black dots were not observed. Thus, clinical, trichoscopic, and histopathological correlation confirmed the diagnosis of Lichen Planopilaris (LPP). The patient was started on 15 mg weekly oral methotrexate after baseline evaluation. During workup for LPP, the patient was newly diagnosed with uncontrolled Type 1 Diabetes Mellitus and was initiated on insulin therapy. As oral steroids  \nFIGURE 4 | Histopathological image (40×) . Histopathology shows interface dermatitis, and melanin incontinence.  \nFIGURE 5 | Histopathological image (40×) . Histopathology shows follicular plugging, interface dermatitis, and band like ","cbCaitbCEaym61Yo","https://ap.wps.com/l/cbCaitbCEaym61Yo","pdf",1035812,"English","# Abstract\n# Case Presentation\n## Diagnostic Options\n# Discussion\n## Diagnostic Exclusions\n## Clinical, Trichoscopic, and Histopathologic Correlation\n## Treatment Approach\n# Author Contributions\n# Acknowledgments","[{\"question\":\"What treatment was started after baseline evaluation?\",\"answer\":\"The patient was started on 15 mg weekly oral methotrexate after baseline evaluation. Because steroids may worsen hyperglycemia and hydroxychloroquine can induce hypoglycemia in patients receiving insulin, methotrexate was preferred as the systemic agent in this case.\"}]","Moth-Eaten Pattern of Alopecia in Lichen Planopilaris | PDF",1790732066]