Lichen Planopilaris in Women

Larkin, Sydney; Cantwell, Hafsa M.; Imhof, Reese L.; Torgerson, Rochelle R.; Tolkachjov, Stanislav N.

doi:10.1016/j.mayocp.2020.02.028

Cited by 16 publications

(7 citation statements)

References 66 publications

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“…Hence, there is a rationale for the use of NAC in LPP. Previous studies have found the combination of topical and systemic therapies are important to achieve slowing or stabilization of disease [26][27][28]. According to our findings, the concomitant use of clobetasol plus PTX was also an interesting combination with better outcomes than clobetasol in monotherapy.…”

Section: Discussionsupporting

confidence: 66%

A Systematic Review and Bayesian Network Meta-Analysis of Medical Therapies for Lichen Planopilaris

Husein-ElAhmed,

Husein-ElAhmed

2023

Dermatology

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BACKGROUND: Lichen planopilaris (LPP) is a primary chronic lymphocytic cutaneous disorder that selectively destroys the hair follicles, resulting in a scarring alopecia. Unfortunately, current available treatments are not fully effective to stop hair loss, and the level of evidence for medical interventions is weak. METHODS: A systematic review and meta-analysis was performed including randomized trials that report the outcomes of lichen planopilaris activity index (LPPAI). These articles were pooled and a network meta-analysis (NAM) was conducted. RESULTS: A total of seven studies was identified and included in meta-analysis, comprising 251 LPP patients. The NMA showed the mean difference in LLPAI was significantly superior with the combination of clobetasol plus N-acetylcysteine (mean difference: -2.0, 95%CI=-3.43- -0.51) and the combination of clobetasol plus pentoxyfilline (mean difference: -1.62, 95%CI=-3.0- -0.25) compared to the treatment of reference (clobetasol). The NMA showed cyclosporine (mean difference: 2.05 95%CI= 0.68-3.49), methotrexate (mean difference: 1.95 95%CI= 1.23-3.17), the combination of methotrexate plus prednisolone (mean difference: 1.56 95%CI= 0.25-2.96) were significantly worse than hydroxychloroquine according to the differences in LLPAI. CONCLUSION: This work is the first NMA in LPP and hence, it can be helpful serving as an initial step towards better evidence-based decisions in the treatment of this challenging condition. We propose a triple combined approach consisting of topical clobetasol, hydroxychloroquine and N-acetylcysteine as resulted in the most effective approach. Considering the poor outcomes observed with pioglitazone, mycophenolate mofetil, and cyclosporine, it is advisable to contemplate the use of these medications in patients who have not responded adequately to more efficacious alternatives.

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Section: Discussionsupporting

confidence: 66%

A Systematic Review and Bayesian Network Meta-Analysis of Medical Therapies for Lichen Planopilaris

Husein-ElAhmed,

Husein-ElAhmed

2023

Dermatology

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“…This result is consistent with those of previous studies that showed a significant association between LPP and thyroid disease. 7,[35][36][37] LPP is believed to be an autoimmune disorder caused by disruption of immune privilege in the hair follicle bulge area. 38 Considering that the most common cause of thyroid disease is an autoimmune disorder, the link between LPP and thyroid disease may be attributed to autoimmunity caused by molecular mimicry or lack of immune tolerance.…”

Section: Discussionmentioning

confidence: 99%

“…Thyroid and metabolic disorders are reported to be associated with LPP. [6][7][8][9] However, some studies have shown that LPP is not associated with thyroid and metabolic disorders. [10][11][12][13] These inconsistent findings are largely attributable to the small number of patients included in these previous studies owing to the rarity of PCA.…”

Section: Introductionmentioning

confidence: 99%

Endocrine and metabolic comorbidities in primary cicatricial alopecia: A nationwide population‐based study

Yu,

Kim,

Cho

et al. 2023

The Journal of Dermatology

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Primary cicatricial alopecia (PCA) is a rare, scarring, hair loss disorder. Due to its low incidence, little is known about endocrine and metabolic comorbidities in patients with PCA. Thus, we aimed to investigate the association between PCA and endocrine and metabolic disorders. This nationwide, population‐based, cross‐sectional study included patients diagnosed with PCA or non‐cicatricial alopecia (NCA) and normal individuals without history of alopecia registered in the Korean National Health Insurance Service database between January 1, 2011, and December 31, 2020. We calculated the odds ratios of endocrine and metabolic comorbidities of patients with PCA compared to all patients or age‐ and sex‐matched patients with NCA or normal individuals using multivariable logistic regression models. A total of 3 021 483 individuals (mean age [SD], 38.7 [15.0] years, 1 607 380 [53.2%] men), including 11 956 patients with PCA, 601 852 patients with NCA, and 2 407 675 normal participants, were identified. Patients with PCA had an increased risk for dyslipidemia (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.06–1.24), diabetes (aOR 1.38, 95% CI 1.24–1.53), and hypertension (aOR 1.10, 95% CI 1.02–1.19) compared to matched patients with NCA. Regarding PCA subtypes, lichen planopilaris/frontal fibrosing alopecia was positively associated with hypothyroidism (aOR 2.03, 95% CI 1.44–2.86) compared to NCA. Folliculitis decalvans and dissecting cellulitis were positively associated with dyslipidemia (aOR 1.16, 95% CI 1.05–1.28 and aOR 1.16, 95% CI 1.04–1.29, respectively), diabetes (aOR 1.38, 95% CI 1.20–1.58 and aOR 1.52, 95% CI 1.32–1.74, respectively), and hypertension (aOR 1.10, 95% CI 1.00–1.20 and aOR 1.14, 95% CI 1.02–1.27, respectively). Similar trends were observed when each PCA subgroup was compared with the normal control group. This study demonstrates that patients with PCA are more likely to have endocrine and metabolic comorbidities than patients without PCA. Further research on these comorbidities may improve the understanding of PCA.

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“…3,6 Lesions of LPP have also been described in all areas of the scalp. 2,4,[7][8][9][10] Figure 1 Lichen planopilaris hair loss patterns.…”

mentioning

confidence: 99%

“…9 In a Mayo clinic study performed only on women (Caucasians, Afro American, Asian, Hispanic, and mixed race), hair loss predominated at the vertex. 10 The objective of this descriptive study is to propose a clinical classification of alopecic patterns in LPP considering patient's ethnicity. Medical records and images from 2012 to 2020 from the Trichology unit in Hospital Universitario 'Dr.…”

mentioning

confidence: 99%