LPP can present as patchy, marginal, or patterned alopecia in its different variants that include “classical LPP”, frontal fibrosing alopecia (FFA), and FAPD, which is a variety of LPP characterized by the presence of miniaturization. LPP is more common in women than men, with peak onset between 30 and 60 years of age . Initially, patients will commonly experience increased hair shedding, pruritus, tenderness, and burning of the scalp. In active disease, trichoscopy shows peripilar casts often surrounding tufts of hairs. Scalp erythema is also usually present. Hair loss becomes more evident with progression of the disease with the eventual disappearance of follicular openings in affected areas [15, 16]. LPP generally has a slow and insidious course of disease, although less frequently, extensive hair loss can occur within months in a more rapid disease course [14, 17].
Currently, as a result of the infrequency of the disease and limited literature availability, no definitive treatment approach has been recognized. There remains no curative therapy and the main goal of treatment is reducing inflammatory symptoms and slowing the progression of hair loss. Treatment commonly involves the use of high potency topical and/or intralesional corticosteroids and orally administered hydroxychloroquine . Other systemic treatment options include tetracyclines, pioglitazones, cyclosporine, mycophenolate mofetil, methotrexate, or systemic corticosteroids. A systematic review concluded that topical/intralesional steroids or hydroxychloroquine can be seen as first-line agents for treating classic LPP, although this is not based on direct comparisons and the quality of evidence for many therapeutic options is low . In recent years, naltrexone has been shown to have anti-inflammatory properties with the potential to be used as a treatment modality for autoimmune conditions . A case series of four patients on low dose naltrexone for treatment of LPP is the only study on the subject and has shown therapeutic benefits including a decrease in inflammation and inflammatory symptoms with slowed disease progression  (Table 2).
LLLT is a non-invasive therapy that has shown some effectiveness in treating inflammatory skin disorders. A literature review on use of LLLT in lichenoid conditions showed that LLLT is an effective therapy for oral LPP where it can be seen as an alternative to corticosteroids [8,9,10,11,12,13].
Two studies directly looked at the effectiveness of LLLT for the treatment of scarring alopecia including FFA and LPP with a total of 24 subjects. Results showed promising findings including a reduction of symptoms and decreased inflammation [6, 7].
Our experience supports the limited existing literature on the use of LLLT for patients with LPP; in particular, we suggest this treatment in cases of LPP that have incomplete response to topical and systemic therapy with steroids and antimalarials. Our patients had consistent improvement with reduction of inflammation, disappearance of symptoms, and evident hair regrowth with no side effects. All patients are still on LLLT treatment, and two of them were able to reduce the oral medications without relapses. The downside of this treatment could be the cost of highly sophisticated devices, daily regimen, and the lack of clear treatment protocol and parameters. Moving forward, larger controlled studies should be performed to fully elucidate the benefits of LLLT and to evaluate the best treatment regimen of this technology for patients with LPP.