Shampoos and lichen planus !

I’m often asked if their are any special shampoos that a patient with LPP should consider. Should they be sulphate free? What about paraben free?

First off, there most certainly can be specific shampoo recommendations for some individuals with LPP. These include antidandruff shampoos, steroid shampoos and low allergen shampoos. however, not every patient with LPP needs these as we’ll see below.

1. Antidandruff shampoos
Compared to the general population, a higher than normal proportion of people with LPP have seborrheic dermatitis. (See article: “Seborrheic dermatitis in LPP : Is it more mor common than we think?”) If seborrheic dermatitis is diagnosed by the dermatologist, my strong recommendation is that it be aggressively treated. Seborrheic dermatitis may contribute to the ongoing inflammation that drives the immune system. A variety of antidandruff shampoos are used to treat seborrheic dermatitis.

2. Corticosteroid shampoos
Second, sometimes corticosteroid shampoos are recommended by the dermatologist. Clobex shampoo, containing clobetsol proportionate, is one such example of a steroid shampoo. This steroid shampoo helps reduce inflammation in LPP and some of my patients use twice weekly when LPP is flaring and others use once every two weeks when LPP has settled down. Not everyone with LPP should be using corticosteroid shampoos but these shampoos are an option.

3. Low allergen shampoos
Are far as using shampoos that are low in allergens and irritants (ie. sulphate-free, paraben-free), this is handled on a case by case basis. If the patient is troubled by ongoing dryness, I might recommend use of some very hydrating oils like fluocinonide oil (a corticosteroid oil) together with use of a sulphate free antidandruff shampoo. Sulphates can be drying for some.

But for the most part, the ingredients of a shampoo don’t appear to be a primary consideration in what we understand about LPP so far. Whether one uses or does not use parabens, silocones, sulphates does not appear to affect disease activity for most.

The exception of course is those with shampoo allergy which is a very much underdiagnosed issue (see former article “Shampoo Allergy”). Patients can be allergic to Ingredients like fragrance, cocamidoproplybetaine, and a few others. These patients have scalp redness as would be expected for anyone with LPP but also have rashes on the face, ears, eyes, neck and chest. Patch testing by a dermatologist can help uncover these allergies. A variety of very bland shampoos can be considered while awaiting results (Free and Clear, Sensinol, etc).

Conclusion
There may be specific shampoos that patient with lichen planopilaris (LPP) and other scarring alopecia are recommended to use. However, these are handled on a case by case basis according to the unique situation fo the patient. There is no universal recommendation on shampoos.