Discussion
G raham-Little-Piccardi-Lassueur syndrome GLPLS was first
described by Piccardi in 1913. A second case was then described by
Graham-Little in 1915 in a patient referred by Lassueur, resulting in
the name it bears today 3. Around 50 cases of GLPLS
have been reported since then4.The condition presents
most commonly in middle-aged white women and is characterized by a triad
of cicatricial alopecia of the scalp, nonscarring alopecia of the
axillae and/or groin, and a follicular papule over body. Its cause
remains unknown, but more likely is a T-cell mediated autoimmune
condition 4. Recent studies showed that there is
decrease expression of peroxisome proliferator-activated receptor (PPAR)
and many patients respond well to PPARγ agonists 5.also, interferon and JAK singling is upregulated in
LPP6.
The goal of treatment in GLPLS as well as in other scarring alopecia is
to prevent progression of hair loss thus early diagnosis and
intervention is crucial 1. Many treatment modalities
have been used in treating lichen planopilaris with variable results.
Treatment options range from topical and intralesional steroid to
systemic treatment such as hydroxychloroquine, cyclosporine and
pioglitazone7. Baibergenova and Walsh8 used PPARγ agonists (Pioglitazone) which induced
complete remission in 25% and significantly improved symptoms in 50%
of patient diagnosed to have LPP. Pioglitazone side effects are very
mild including calf pain, lightheadedness, nausea, dizziness, and hives
which were experienced by less than 5% of patients8.
Chiang et al 9 studied the use of hydroxychloroquine
in the treatment of LPP in 40 patients for twelve months. Their results
showed that hydroxychloroquine was very effective in terms of
controlling symptoms and halting disease progression with a 69% and
83% significant reduction in severity of LPP at both 6 and 12 months
respectively. Treatment with oral tofacitinib either as monotherapy or
as adjuvant to other treatment showed measurable 80% improvement
clinically6.Excimer laser(308-nm) was used by Navarini
et al twice weekly in 13 patients and all patient experienced relief of
pruritus with 40% reduction in inflammation but only 25% of patients
had hair regrowth10. Finally, naltrexone was used and
showed improvement mainly in term of relieving symptoms such as
pruritus11. Our patient was started on
hydroxychloroquine after he was evaluated by ophthalmology and there was
no contraindication to start the medication. In addition, the patient
was started on topical treatment in the form of tretinoin 0.05% cream
targeting follicular keratotic papules. On follow up, the patient
reported improvement in term of pruritis and reduction on the severity
of follicular keratotic papules.