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ABSTRACT Background Methods Results Conclusions Lichen planopilaris (LPP) is the most common form of scarring alopecia in adults. The disease may also occur in children and adolescents. The aim of this systematic review is to evaluate clinical, trichoscopic, and histopathologic features of pediatric LPP. Therapeutic management is also discussed.The systematic review was performed according to preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines by searching PubMed, Scopus, and EBSCO databases with the last search on June 18, 2024.A total of 12 studies including 20 children were analyzed. Male predominance was observed. The typical presentation of LPP in children included scarring, perifollicular erythema, scaling, and plugging; atrophy, and follicular hyperkeratotic papules, located most commonly in the vertex. The most common trichoscopic findings were scaling and blue‐gray dots, perifollicular erythema, and the absence of follicular ostia. Histopathological examination revealed perifollicular fibrosis, perifollicular interface lymphocytic inflammation, pigment incontinence, cytoid bodies, and scarring in the dermis. Complete or partial response was observed in children treated with topical, intralesional, and systemic corticosteroids, methotrexate, pioglitazone, and tocilizumab.LPP is a rare cause of scarring alopecia in children. The disease should be taken into consideration in the differential diagnosis of patchy hair loss in children. [ABSTRACT FROM AUTHOR]

Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by hairline recession, pruritus, and facial papules (FP). Various therapies are used to stabilize disease activity and induce remission. However, FP of FFA is resistant to treatment in many cases. In this review, we searched the PubMed and Google Scholar databases to screen the published literature on treatment options for FP in the context of FFA. Overall, 12 studies were included in this review. Available literature suggests a noticeable improvement in resistant‐to‐treatment FP in FFA patients with oral isotretinoin. The available evidence is limited and is derived from retrospective studies and case reports/series. Systemic isotretinoin can be considered a promising therapeutic regimen for treating resistant‐to‐treatment FP of FFA patients. However, more extensive, well‐designed studies are necessary for confirmatory evidence. [ABSTRACT FROM AUTHOR]

Blaschko-linear pigmented lesions over the face are encountered rarely, and may either be macular or atrophic. A descriptive clinical, dermoscopic, and histopathological analysis of six such cases of hyperpigmented atrophic lesions in a Blaschko-linear distribution that we saw recently in our outpatient department is presented emphasizing the potential of dermoscopy to facilitate prompt management thereby averting cicatrization.

Background: Lichen planopilaris (LPP) is a chronic lymphocytic skin disease manifested by progressive scarring alopecia. The diagnosis of LPP is made based on histopathological examination, although it is not always definite. The current study evaluates the effectiveness of non‐invasive atomic force microscopy (AFM) hair examination in detecting morphological differences between healthy and diseased hair. Materials and methods: Here, three to five hairs from lesional skin of 10 LPP patients were collected and examined at nine locations using AFM. At least four images were taken at each of the nine sites. Metric measurements were taken and metric (length, width, and scale step height) and morphological features (striated and smooth surface of scales, the presence of endocuticle and cortex, shape of scales edges, scratches, pitting, cracks, globules, and wavy edge) were compared with hair from healthy controls. In addition, areas on diseased hair where the process of pathological, unnatural delamination of the hair fiber occurs are described. Results: There was a statistically significant difference in the number of scratches in the initial sections of the LPP hair, in the intensity of wavy edges along the entire length of the tested hair, and in the number of scales with pitting in the middle section of the hair. In addition, a statistically significant higher number of scales with striated surface was found in LPP group starting at 3.5 cm from the root continuing towards the free end of the hair. Other morphological changes such as presence of cortex, globules, oval indentations, and rod‐like macrofibrillar elements were also assessed, however, detailed results are not presented, as the differences shown in the number of these morphological changes were not significantly different. Conclusion: This publication outlines the differences between virgin, healthy Caucasian hair, and the hair of LPP patients. The results of this study can be used for further research and work related to LPP. This is the first attempt to characterize the hair of LPP patients using AFM. [ABSTRACT FROM AUTHOR]

Background: Lichen planopilaris (LPP) is an inflammatory cicatricial alopecia characterized by an irreversible destruction of the hair follicle resulting in its permeant destruction. The clinical presentation of LPP is a progressive patchy scarring alopecia. A variety of systemic agents is used to treat LPP with varying success. The aim of this retrospective, real-life analysis was to evaluate the treatment of hydroxychloroquine for LPP. Method: In this retrospective, single-center study, we analyzed 110 patients with LPP and frontal fibrosing alopecia (FFA) who received treatment over a 12-month period from March 2014 to March 2021 at the Department of Dermatology, University of Mainz Medical Center. Patient records were analyzed for response to treatment, co-morbidities, disease progression-free survival (DPFS), and safety. Clinical parameters associated with treatment response were determined with Cox regression modelling and logistic regression. Results: Overall, 77 of 110 patients were treated with a systemic agent. There was a clear association between LPP and the occurrence of Hashimoto thyroiditis. Topical treatment with corticosteroids did not improve clinical symptoms in the majority of patients (15 out of 101). In 71% of patients treated with systemic cyclosporine A and 62% of patients treated with hydroxychloroquine, we observed a significant resolution of the inflammatory process, which correlated with a robust durable clinical response (p < 0.001). Toxicity was observed in 17% (n = 9) of patients receiving systemic treatment with hydroxychloroquine and correlated with the duration of systemic treatment (p < 0.001). Treatment discontinuation was associated with a flare-up of clinical symptoms (29%), which required the re-initiation of second-line therapy in 13 out of 51 patients. Overall, the initiation of second-line treatment, either hydroxychloroquine or Cyclosporine A (CsA), yielded positive results, especially in the patient cohort treated with hydroxychloroquine (overall response rate, ORR = 100%), who showed disease progression during CsA or retinoids. Conclusions: Our results from this contemporary cohort of patients with LPP and FFA indicate that hydroxychloroquine and cyclosporine are effective systemic agents in decreasing clinical symptoms. However, our data also show that the discontinuation of treatment is often associated with the exacerbation of clinical symptoms. Response rates to second-line treatment were especially favorable in the patient cohort with hydroxychloroquine. [ABSTRACT FROM AUTHOR]

Background: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are the most common causes of lymphocytic scarring alopecia. Itching of the scalp is a common accompanying symptom. The aim of the study was the clinical assessment of pruritus and its correlation with dermoscopic features. Methods: Sixty-one patients with scarring alopecia were analyzed (LPP = 16; FFA = 33; coexisting LPP-FFA = 12). Each patient underwent a trichoscopic examination. Itch severity and characteristics were assessed using a Visual Analogue Scale (VAS), 4-item Itch Questionnaire and 12-item Descriptive Pruritus Assessment Questionnaire. Results: Itching of the scalp occurred in 73.8% of the patients (mean maximal VAS 5.3 ± 3.1 points). Pruritus was most frequently accompanied by tingling (19.7%) or burning (14.8%) sensations. The following factors most frequently increased the severity of pruritus: sweating, heat, stress and hot water. On the other hand, cold water and cold air often relieved symptoms. There was a significant relationship between itch and perifollicular scaling (p = 0.011), hair diameter diversity (p = 0.008) and white halo (p = 0.016). Conclusions: Pruritus was the main subjective complaint reported by patients suffering from LPP and FFA. A better understanding of pruritic features may help in the selection of an effective therapeutic strategy. [ABSTRACT FROM AUTHOR]

Introduction: Lichen planopilaris (LPP) is an inflammatory, primary scarring alopecia, however its pathogenesis is not completely elucidated. S100A7 is a multifunctional, antimicrobial protein with proinflammatory properties. Interleukin-17 (IL-17) is implicated in the development of various autoimmune skin diseases. Aim: To determine the tissue expression of S100A7, S100A4 and IL-17 in LPP Material and methods: The immunohistochemical analysis was performed on biopsy specimens obtained from individuals with histologically confirmed lichen planopilaris (n = 23), alopecia areata (AA) (n = 11), and healthy controls (n = 14). The expression was evaluated using Zeiss Axio Imager A2 light microscope. Results: The number of cells showing S100A7 expression was significantly higher in LPP lesional skin compared to AA lesional skin (p = 0.0002) and normal skin of healthy controls (p < 0.0001). The number of cells showing IL-17 expression was significantly higher in LPP lesional skin compared to normal skin of healthy controls (p < 0.0001) and the number of cells showing IL-17 expression was significantly higher in AA lesional skin compared to normal skin of healthy controls (p < 0.0001). The number of cells showing IL-17 expression was not significantly different in LPP lesional skin and in AA lesional skin (p > 0.05). The number of cells showing S100A4 expression was not significantly different in LPP lesional skin, AA lesional skin and in normal skin of healthy controls. Conclusions: The results of our study suggest the possible role of S100A7 and IL-17 in the pathogenesis of LPP. [ABSTRACT FROM AUTHOR]

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary cicatricial alopecia that cause a major impact on quality of life due to irreversible hair loss and symptoms as itching, burning and pain. They are characterized by permanent loss of hair follicle stem cells (HFSCs) by pathomechanisms still poorly understood, resulting in poor efficacy of currently available treatments. Caveolae are flask-shaped lipid rafts invaginated within the plasma membrane of multiple cell types. Although their role in the HF physiology and pathophysiology is relatively unknown, we have previously demonstrated that the primary structural component of caveolae (caveolin-1 or Cav1) is upregulated in FFA. Thus, we propose to investigate the expression and localization of caveolae-associated structural proteins (Cav1, Cav2, and Cavin-1) and HFSCs (identified by K15) in both LPP and FFA. We analyzed 4 patients with LPP biopsied in affected and non-affected (NA) scalp, 4 patients with FFA biopsied in affected scalp and 4 healthy controls. Affected scalp of LPP and FFA demonstrated increased levels of Cav1 and Cavin-1 compared with HC and LPP-NA. Moreover, Cav1, Cav2 and Cavin1 all exhibit high colocalization with K15 and their expression appears to be negatively correlated, supporting the hypothesis that these proteins are important players in LPP/FFA and may serve as therapeutic targets in future treatments. [ABSTRACT FROM AUTHOR]

Introduction: Lichen planopilaris (LPP) is one of the most common causes of scarring hair loss caused by immune‐mediated inflammation resulting in atrophy and scaling. The key to preventing this irreversible hair loss is diagnosing and starting treatment at the earliest possible stage. As there is no definite cure for LPP, the therapy could be challenging. In the study, we conducted a single‐blinded randomized clinical trial to evaluate the therapeutic effects, safety, and tolerability of platelet‐rich plasma versus topical clobetasol in the treatment of LPP. Method: A randomized single‐blinded controlled clinical trial was conducted in 24 LPP patients referring to our dermatology clinic between August 2022 and March 2023. Patients in the control group were treated with topical clobetasol 0.05% applied at night, and patients in the case group, in addition to topical clobetasol, received three sessions of PRP injection monthly. Both groups were assessed 1, 2, and 6 months after the start of the study by the Lichen Planopilaris Activity Index (LPPAI), physician and patient satisfaction, tolerability, and recording adverse effects. Results: The average age in the clobetasol and PRP groups was 43.75 ± 13.51 and 42.75 ± 9.67, respectively (p = 0.83). In terms of gender, all 12 cases (100%) in the clobetasol group and 9 cases (75%) in the PRP group were female (p = 0.21). Both PRP and topical clobetasol effectively reduced LPPAI in the first 2 months; however, after 6 months, the LPPAI significantly increased in the clobetasol group (p = 0.001). There were no significant differences in LPPAI between the two groups at the beginning of the study and after 1 month. However, the mean LPPAI score in the clobetasol group was significantly higher than in the PRP group at 2 and 6 months after the start of the study (p = 0.01). Patient satisfaction with treatment increased in both groups during follow‐up sessions, but at the end of the follow‐up period, it was significantly higher in the PRP group (p = 0.03). Finally, the study did not have any serious adverse effects, and the pain experienced during PRP injection was tolerable for the patients. Overall, treatment tolerability was excellent in both groups. Conclusion: Given the different efficacy profiles, PRP could be considered a new and effective choice for the treatment of LPP. [ABSTRACT FROM AUTHOR]

Central centrifugal cicatricial alopecia (CCCA) is a lymphocytic scarring alopecia that predominantly affects middle-aged women of African descent. Despite its prevalence and impact, the disease remains underdiagnosed and understudied. Recent theories suggest that CCCA may be a subtype of lichen planopilaris occurring within a specific racial group, given their near-identical clinical and histological characteristics. This review article explores the epidemiology, pathogenesis, clinical presentation, trichoscopy, histology, and management of CCCA, emphasizing the similarities and differences between these two entities. [ABSTRACT FROM AUTHOR]

Introduction: Lichen planopilaris (LPP) is a common type of primary cicatricial alopecia. Previous studies focused on the epidemiology, clinical characteristics, and treatment of LPP. A lack of knowledge regarding LPP outcomes and prognostic factors remained. Methods: To delineate the rate and timing of remission in LPP, as well as the prognostic factors for achieving remission, a retrospective cohort study was conducted. The study included 126 patients, from a single tertiary center, diagnosed with LPP between January 2010 and December 2022, who were followed up for a minimum of 6 months.Results: There were 89 (70.6%) women and 37 (29.4%) men included in this study. The mean age of the patients was 47.92 ± 14.2 years. The mean time from disease onset to diagnosis was 33.85 (±30) months, indicating significant diagnostic delays. The mean duration of follow-up was 34.13 ± 22.7 months. Among the cohort, 43 patients achieved complete remission (CR) during the follow-up period, whereas 83 patients did not. Of the 83 patients who did not achieve CR, 35 partially improved and 48 did not improve or worsened. The median time for achieving CR was 46 ± 18.8 months. Milder disease at presentation and comorbid lichen planus were associated with higher CR rates. Conclusion: This study demonstrates significant diagnostic delays that should be addressed as LPP causes irreversible alopecia, suggests disease severity and comorbid lichen planus as potential prognostic factors. Further, it emphasizes the limited efficacy of current treatments and the need for prolonged treatment in patients with LPP to achieve remission. [ABSTRACT FROM AUTHOR]

Introduction: Few publications are available on eyebrow trichoscopy in patients with alopecia areata and frontal fibrosing alopecia (FFA). Objective: We aimed to investigate the validity of using trichoscopy to examine the eyebrow involvement in patients with lichen planopilaris (LPP) and its variants. Methods: In this case control study, 109 patients with eyebrow involvement in LPP and FFA (cases) and with acquired hair disorders of the eyebrows (controls) were included. Results: Trichoscopy was highly specific and sensitive for the diagnosis of LPP and its variants, including FFA. Trichoscopic features significantly associated with LPP were peripilar scaling, peripilar pigmentation, broken hairs, peripilar white halos, diffuse empty follicles, and vellus hair. Localized peripilar erythema and empty follicles were significantly associated with the diffuse form of LPP and zigzag-type FFA. Yellow dots, dystrophic hairs, regrowth in different directions, and diffuse empty follicles were associated with LPP activity and FFA severity. Conclusions: Trichoscopy is a valid tool for evaluating eyebrow involvement in LPP. Thus, it could help increase the diagnostic accuracy and predict the prognosis of eyebrow hair loss at an early stage.

The article discusses a case series where five patients with recalcitrant lichen planopilaris (LPP) were treated with oral upadacitinib, a JAK1 inhibitor. The patients showed improvement in severity scores, with four of them experiencing hair regrowth. Side effects were mild, and no patient discontinued the treatment. The study suggests that upadacitinib could be effective in treating LPP, but more extensive research is needed to confirm these findings due to the study's limitations. [Extracted from the article]

The article "Haircare practices and scarring alopecia: a survey study" published in the International Journal of Dermatology discusses the potential association between haircare practices and scarring alopecia development. A survey of 265 individuals with scarring alopecia revealed common practices such as heat styling, dyeing, chemical treatments, and high-tension hairstyles. The study found that chemical treatments and high-tension hairstyles were associated with a younger age at first hair loss or alopecia diagnosis, while hair dye use was linked to an older age at onset. Further research with a diverse cohort is needed to explore these relationships and empower patients to make informed choices about their haircare routines. [Extracted from the article]

Shreya K Gowda,1 Enzo Errichetti,2 Vishal Thakur,1 Maitreyee Panda,3 Siddhartha Dash,4 Akash Agarwal,3 Madhusmita Sethy,5 Pavithra Ayyanar,5 Biswanath Behera1 1Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, OD, India; 2Institute of Dermatology, Department of Medicine, University of Udine, Udine, Italy; 3Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, OD, India; 4Department of Dermatology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, OD, India; 5Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, OD, IndiaCorrespondence: Biswanath Behera, Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, 751019, India, Email biswanathbehera61@gmail.comIntroduction: Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are primary scarring alopecias that pose diagnostic challenges clinically, where trichoscopy features may provide benefit in delineating these two cicatricial alopecia, and also helps in assessing the evolution and therapeutic response. To date, there are few reviews on dermoscopic findings in differentiating these two alopecias.Methods: A systematic literature review was conducted using the PubMed and Google Scholar databases. The search terms included for scalp DLE were ‘lupus’ OR ‘discoid lupus’ OR “scalp lupus” and for scalp LPP were “lichen planopilaris” OR “scalp follicular lichen planus” OR “lichen planus follicularis” and were combined with “dermoscopy” OR “dermatoscopy” OR “videodermoscopy” OR “video dermatoscopy” OR “trichoscopy”. The differences in the prevalence of dermoscopic features in scalp DLE and LPP were calculated using the Chi-square test.Results: Of 52 articles, 36 (17 LPP, 19 DLE) were eligible for quantitative analysis. We found predominant peripilar tubular casts and perifollicular erythema with the presence of arborizing vessels in the vicinity of these changes, indicating early LPP. In contrast, follicular red dots, speckled brown pigmentation, and hair diameter variability indicated active DLE. Shiny white areas were common in both the groups in late stages. The target pattern of distribution of blue-grey dots, milky red areas, and irregular white fibrotic dots were seen in LPP, and pink-white background, follicular plugs, perifollicular and interfollicular scale, rosettes, chrysalides, and red spider on yellow dots were detected in DLE. Features such as yellow dots and blue-grey structureless areas were nonspecific and did not have a major role in differentiating DLE from LPP.Conclusion: This article provides a comprehensive review of the literature and delineates the trichoscopic differences and peculiarities of scalp DLE and LPP, including the correlation of dermoscopic features with histopathological findings.Keywords: scalp discoid lupus erythematosus, lichen planopilaris, trichoscopy, dermoscopy, primary cicatricial alopecia

PURPOSE: Folliculitis decalvans (FD) is a difficult-to-treat, localized scarring alopecia characterized by an expanding area of chronically inflamed purulent plaques or masses. Current treatment modalities vary and often result in only temporary remission. There are no reports of surgical therapies for FD. Here, we describe FD treatment using surgical excision and second-intention healing aided by guarded high-tension sutures. METHODS: Five patients (one woman and four men) with histologically confirmed FD were treated by surgical lesion excision. All wounds were allowed to heal via second-intention. Guarded high-tension sutures were employed to minimize tissue tears while aiding and guiding wound contraction. RESULTS: All wounds healed with a 47-83% spatial contraction of the maximum wound diameters. Three patients healed entirely by second-intention, while two required a minor skin graft to close the wound completely. No disease recurrence was noted at 10-24 months. CONCLUSION: Surgical excision with second-intention healing aided by guarded high-tension sutures effectively treated small and extensive FD lesions with no recurrence at long-term follow-up. To our knowledge, this is the first report of successful surgical treatment of FD.

PURPOSE: Small observational studies suggest subclinical disease occurrence in the normal-appearing scalp zones of several primary cicatricial alopecias. To aid patient management, we began routinely evaluating the entire scalp of patients with acne keloidalis nuchae (AKN), including trichoscopy-guided biopsies. PATIENTS AND METHODS: This retrospective study evaluated 41 patients sequentially presenting with AKN at a single clinic between June and December 2022. Primary lesions and normal-appearing scalp in the superior parietal scalp at least 5 cm away from AKN-affected zones were clinically evaluated, and areas showing perifollicular erythema or scales/casts on trichoscopy were biopsied and histologically analyzed. RESULTS: Forty-one men with AKN, including 20 men of African descent, 17 Hispanic, and 4 European-descended Whites, were evaluated. All patients, including 22% with associated folliculitis decalvans, showed scalp-wide trichoscopy signs of perifollicular erythema or scaling in normal-appearing scalp areas. All patients showed histologic evidence of perifollicular infundibulo-isthmic lymphocytoplasmic infiltrates and fibrosis (PIILIF), with 96% showing Vellus or miniaturized hair absence. PIILIF was often clinically mistaken for seborrheic dermatitis (44-51%). All White patients had mild papular acne keloidalis nuchae lesions mistaken for seborrheic dermatitis. CONCLUSION: PIILIF may be a precursor to a wide spectrum of primary cicatricial alopecias, including AKN and folliculitis decalvans. This finding carries implications for the early diagnosis and management of AKN and other primary cicatricial alopecias.

This article provides a review of the use of Janus Kinase inhibitors (JAKi) in the treatment of various types of scarring alopecia. It discusses the potential benefits of JAKi therapy in improving symptoms and hair regrowth in patients with conditions such as lichen planopilaris, central centrifugal cicatricial alopecia, folliculitis decalvans, frontal fibrosing alopecia, and dissecting cellulitis of the scalp. The article acknowledges the need for further research to fully understand the effectiveness and potential side effects of JAKi in this context. Overall, JAKi therapy shows promise but more investigation is required. [Extracted from the article]

Background Lichen planus (LP) is a common inflammatory disorder of the skin and mucous membranes having an unknown etiology. In addition to skin and mucous membranes, it also involves nails and hair. Classically it is characterized by pruritic, purple, polygonal, plan-topped papules and may have different clinical presentations like erosive, hypertrophic, atrophic, follicular (Lichen planopilaris), linear, actinic, pigmentosus, annular, guttate, and vesiculobullous. In recent years, many research articles showed association of Lichen planus with HCV infection. So, it is important to establish the clinical role of Lichen planus in the diagnosing of hepatitis C virus is an a pivotal and practical task. Methods This is a cross sectional study, having consecutive sampling of Non probability type. It is conducted at department of dermatology, Sandeman (Provincial) Hospital/ Bolan Medical College Quetta between January 2018 to June 2018. All the patients of either gender, aged 30 to 60 years and clinically diagnosed with Lichen Planus were enrolled. After a complete history and clinical examination, anti HCV antibodies was checked by kit method in the institutional laboratory. Results The mean age was 46.42 ±9.75 years. There were 89 (53.9%) females while 76 (46.1%) males. Mean duration of symptoms was 3.20±1.16 weeks. Frequency of positive anti HCV antibody was found in 53 (32.1%) patients while 112 (67.9%) patients were found to be negative. Conclusion The results of high frequency of Anti HCV antibodies support a possible association with lichen planus. [ABSTRACT FROM AUTHOR]

Introduction: Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia that represents a form of follicular lichen planus. Case Presentation: We describe a case of coexisting diffuse LPP and female pattern hair loss masquerading as diffuse alopecia areata in a 32-year-old female. Discussion: In complex cases such as this, dermoscopy-guided vertical and horizontal biopsies from androgen sensitive and insensitive areas are helpful in increasing diagnostic yield. Prompt initiation of treatment is key to halting disease progression. Long-term follow-up is important as resolution of clinical signs does not always correlate with the absence of disease progression.

This document presents the findings of a study on lichen planopilaris (LPP), a hair loss condition. The study found that LPP primarily affects postmenopausal White females, but also has a disproportionate impact on elderly patients of different racial and ethnic backgrounds. The study also suggests a potential link between cigarette smoking and LPP, as well as the role of certain biological factors in the development of the condition. However, the study acknowledges limitations, such as reliance on electronic health records and the need for further research using a more representative database. [Extracted from the article]

Lichen planus (LP) is a chronic inflammatory disorder primarily affecting the skin and mucous membranes, characterized by pruritic, violaceous papules often exhibiting a polygonal pattern. This dermatological disorder can affect various sites of the body, including the skin, nails, hair, and mucous membranes out of which the oral mucosa is the most commonly affected. We report a case of a 40-year-old female with a unique combination of cutaneous, nail, and mucosal LP manifestations coexisting with lichen planopilaris and vulvovaginal-gingival syndrome. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia that represents a form of follicular lichen planus. Case Presentation: We describe a case of coexisting diffuse LPP and female pattern hair loss masquerading as diffuse alopecia areata in a 32-year-old female. Discussion: In complex cases such as this, dermoscopy-guided vertical and horizontal biopsies from androgen sensitive and insensitive areas are helpful in increasing diagnostic yield. Prompt initiation of treatment is key to halting disease progression. Long-term follow-up is important as resolution of clinical signs does not always correlate with the absence of disease progression. [ABSTRACT FROM AUTHOR]

Background: Lichen planopilaris (LPP) is a primary chronic lymphocytic cutaneous disorder that selectively destroys the hair follicles, resulting in scarring alopecia. Unfortunately, current available treatments are not fully effective to stop hair loss, and the level of evidence for medical interventions is weak. Objectives: The present article aimed to determine the efficacy of the different medical interventions in LPP through a network meta-analysis (NMA). Methods: A systematic review and meta-analysis were performed including randomized trials that report the outcomes of lichen planopilaris activity index (LPPAI). These articles were pooled and a NMA was conducted. Results: A total of seven studies were 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 to −0.51) and the combination of clobetasol plus pentoxifylline (mean difference: −1.62, 95% CI = −3.0 to −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 in serving as an initial step toward 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. [ABSTRACT FROM AUTHOR]

Sanusi Umar,1– 3 Ade Waterman,3 Donna Ton,3 Paul Shitabata1,2,4 1Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; 2Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA; 3Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA; 4Dermatopathology Institute, Torrance, CA, USACorrespondence: Sanusi Umar, Dr. U Hair and Skin Clinic, 2121 N. Sepulveda Avenue, Suite 200, Manhattan Beach, CA, 90266, USA, Tel +1 310 318-1500, Fax +1 310 318-1590, Email drumar@dru.comPurpose: Folliculitis decalvans (FD) is a difficult-to-treat, localized scarring alopecia characterized by an expanding area of chronically inflamed purulent plaques or masses. Current treatment modalities vary and often result in only temporary remission. There are no reports of surgical therapies for FD. Here, we describe FD treatment using surgical excision and second-intention healing aided by guarded high-tension sutures.Methods: Five patients (one woman and four men) with histologically confirmed FD were treated by surgical lesion excision. All wounds were allowed to heal via second-intention. Guarded high-tension sutures were employed to minimize tissue tears while aiding and guiding wound contraction.Results: All wounds healed with a 47– 83% spatial contraction of the maximum wound diameters. Three patients healed entirely by second-intention, while two required a minor skin graft to close the wound completely. No disease recurrence was noted at 10– 24 months.Conclusion: Surgical excision with second-intention healing aided by guarded high-tension sutures effectively treated small and extensive FD lesions with no recurrence at long-term follow-up. To our knowledge, this is the first report of successful surgical treatment of FD.Plain Language Summary: Current treatment modalities of folliculitis decalvans, including steroids, antibiotics, and isotretinoin, are suboptimal, typically resulting in recurrence following the withdrawal of treatments. In this case series, we report a first account of treatment success of refractory folliculitis decalvans using surgical excision with second intention healing aided by guarded high-tension suturing. The outpatient procedure resulted in long-term remission at 10– 24 months follow-up.Keywords: folliculitis decalvans, treatment, surgical treatment, alopecia, primary cicatricial alopecia, acne keloidalis nuchae, lichen planopilaris, surgery, therapy, second intention healing, tension sutures, scaring alopecia, hair loss

Sanusi Umar,1– 3 Donna Ton,3 Marissa J Carter,4 Paul Shitabata1,2,5 1Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; 2Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA; 3Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA; 4Strategic Solutions, Inc., Bozeman, MT, USA; 5Dermatopathology Institute, Torrance, CA, USACorrespondence: Sanusi Umar, Dr. U Hair and Skin Clinic, 2121 N. Sepulveda Boulevard, Suite 200, Manhattan Beach, CA, 90266, USA, Tel +1-310-318-1500, Fax +1-310-318-1590, Email drumar@dru.comPurpose: Small observational studies suggest subclinical disease occurrence in the normal-appearing scalp zones of several primary cicatricial alopecias. To aid patient management, we began routinely evaluating the entire scalp of patients with acne keloidalis nuchae (AKN), including trichoscopy-guided biopsies.Patients and Methods: This retrospective study evaluated 41 patients sequentially presenting with AKN at a single clinic between June and December 2022. Primary lesions and normal-appearing scalp in the superior parietal scalp at least 5 cm away from AKN-affected zones were clinically evaluated, and areas showing perifollicular erythema or scales/casts on trichoscopy were biopsied and histologically analyzed.Results: Forty-one men with AKN, including 20 men of African descent, 17 Hispanic, and 4 European-descended Whites, were evaluated. All patients, including 22% with associated folliculitis decalvans, showed scalp-wide trichoscopy signs of perifollicular erythema or scaling in normal-appearing scalp areas. All patients showed histologic evidence of perifollicular infundibulo-isthmic lymphocytoplasmic infiltrates and fibrosis (PIILIF), with 96% showing Vellus or miniaturized hair absence. PIILIF was often clinically mistaken for seborrheic dermatitis (44– 51%). All White patients had mild papular acne keloidalis nuchae lesions mistaken for seborrheic dermatitis.Conclusion: PIILIF may be a precursor to a wide spectrum of primary cicatricial alopecias, including AKN and folliculitis decalvans. This finding carries implications for the early diagnosis and management of AKN and other primary cicatricial alopecias.Plain Language Summary: Acne keloidalis nuchae (AKN) is a type of hair loss and scalp condition marked by scarring and inflammation. This condition falls under a group of chronic hair and scalp issues known as primary cicatricial alopecia (PCA). Current treatments for AKN and similar PCAs often do not work well, and the condition tends to return. We have found a hidden scalp condition that could be causing AKN and other PCAs. It’s a subtle disease that affects the entire scalp, even though it might not show noticeable symptoms. We have observed this condition in all 41 AKN patients in our study, and it’s characterized by certain changes in the hair and scalp’s structure and immune system response. Other studies have linked this condition to various other PCAs. We believe this hidden condition could be causing AKN and making it come back after treatment. This study suggests that treating AKN might require a broader approach beyond just treating the visible symptoms. Since this hidden condition exists in other PCAs, it might be a common cause.Keywords: folliculitis decalvans, lichen planopilaris, subclinical, central centrifugal cicatricial alopecia, frontal fibrosing alopecia, scarring alopecia

Background: Lichen planopilaris (LPP) is an inflammatory disease that results in destruction of the hair follicle and replaces it with patchy permanent scarring alopecia; after stabilizing by treatment, reactivation is common and may be insidious. During remission, various methods are available for realizing that the disease is activated or not, but neither of them is practical for patients. Objectives: This study aims to evaluate the paper sign test for reactivated LPP by physician and patient. Patients and Methods: In a prospective study, during 2 years, 83 treated LPP patients have been divided into two groups of 41 and 42. Group 1 instructed for paper sign test which is to comb their hair over a white paper sheet to catch any fallen hairs, then turn the paper upside down, if all collected hair on paper completely separated, test is considered negative, if even one hair hangs onto the paper, the test is considered positive. Group 2 trained for clinical symptoms (hair shedding, scaling, itching, pain, tenderness, and burning). Results: From the first group, 13 patients had positive paper sign, and from the second group, 35 patients had clinical symptoms; after clinical examination and biopsy, 13 from Group 1 and 17 from Group 2 were confirmed to have reactivated disease. Patients in the first group who had been trained for paper sign test became aware of relapse sooner and came earlier for the evaluation of disease. Conclusion: Paper sign test is a reliable, noninvasive, and practical test for early detection of reactivated LPP by patients during remission period. [ABSTRACT FROM AUTHOR]

Background: Case identification strategies to conduct population-based studies have not been developed for lichen planus (LP) or lichen planopilaris (LPP). Objectives: The aim of this study was to assess the validity of using diagnostic codes to establish both a cutaneous (non-oral) LP cohort and an LPP cohort from a large clinical database. Methods: A retrospective chart review was performed to determine whether patients with ICD-9 or ICD-10 codes for LP and ICD-10 codes for LPP are confirmed cases of LP and LPP. Validation samples were used to estimate the positive predictive value (PPV) of three case definitions any LP, non-oral LP, and LPP defined as: at least one code by any physician, at least two codes by any physician, and at least one code by a dermatologist. Results: Among the 199 reviewed LP charts, 166 and 123 were confirmed cases of any LP and non-oral LP, respectively. The PPVs for any LP were: 83.4% (166/199) for one code by any physician, 84.6% (77/91) for two codes by any physician, and 95.1% (97/102) for one code by a dermatologist. The PPVs for non-oral LP were: 61.8% (123/199) for one code by any physician, 70.3% (64/91) for two diagnoses by any physician, and 86.3% (88/102) for one diagnosis by a dermatologist. Of the 139 patients with at least one code for LPP, 122 were confirmed cases of LPP. The case definition for one LPP code applied by any physician had a PPV of 87.8% (122/139) to identify a true case of LPP, whereas two diagnoses by any physician had a PPV of 96.2% (76/79) and a diagnosis by a dermatologist had a PPV of 93% (107/115). Conclusions: Diagnosis codes for LP and LPP, restricted by the diagnosing physician's specialty, may be used to accurately identify case cohorts of overall LP, non-oral LP, or LPP in large clinical databases. [ABSTRACT FROM AUTHOR]

Background: Frontal fibrosing alopecia (FFA) is a cicatricial alopecia affecting the frontotemporal hairline. Given that this scarring, immune-mediated follicular destruction most commonly affects postmenopausal Caucasian women, researchers have postulated that there are hormonal and genetic components; however, the etiology of FFA is still unknown. Recently, dermatologists have reported cases of FFA as being potentially caused by cosmetic products, such as sunscreen and shampoo. Therefore, this systematic review and meta-analysis intend to be the first to analyze the relationship between FFA and cosmetic/personal care products and treatments, including sunscreen, moisturizer, foundation, shampoo, conditioner, hair mousse, hair gel, hair dye, hair straightening/rebonding, chemical/laser facial resurfacing, aftershave, and facial cleanser. Methods: The Cochrane, PubMed, EMBASE, and Medline (Ovid) databases were searched for the relevant studies from the date of inception to August 2022. Case–control, cross-sectional, and cohort studies examining the effects of cosmetic/personal care product use on FFA, available in English full-text, were included. Analyses were performed using Review Manager, version 5.4. Results were reported as an odds ratio (OR) with a 95% confidence interval (CI); p values < 0.05 were considered significant. Results: Nine studies were included in our quantitative analyses, totaling 1,248 FFA patients and 1,459 controls. There were significant positive associations found for FFA and sunscreen (OR 3.02, 95% CI 1.67–5.47; p = 0.0003) and facial moisturizer (OR 2.20, 95% CI 1.51–3.20; p < 0.0001) use. Gender sub-analyses demonstrated a positive association for FFA and facial moisturizer in men (OR 5.07, 95% CI 1.40–18.32; p = 0.01), but not in women (OR 1.58, 95% CI 0.83–2.98; p = 0.16). Both gender sub-analyses were significantly positive for the association with facial sunscreen (Male OR 4.61, 95% CI 1.54–13.78, p = 0.006; Female OR 2.74, 95% CI 1.32–5.70, p = 0.007). There was no association found for a facial cleanser (OR 1.14, 95% CI 0.33–1.52; p = 0.51), foundation (OR 1.13, 95% CI 0.83–1.55; p = 0.21), shampoo (OR 0.49, 95% CI 0.22–1.10; p = 0.08), hair conditioner (OR 0.81, 95% CI 0.52–1.26; p = 0.35), hair mousse (OR 1.37, 95% CI 0.75–2.51; p = 0.31), and hair gel (OR 0.90, 95% CI 0.48–1.69; p = 0.74), hair dye (OR 1.07, 95% CI 0.69–1.64; p = 0.77), hair straightening/rebonding (OR 0.88, 95% CI 0.08–9.32; p = 0.92), hair perming (OR 1.41, 95% CI 0.89–2.23; p = 0.14), facial toner (OR 0.51, 95% CI 0.12–2.21; p = 0.37), or aftershave (OR 1.64, 95% CI 0.28–9.49; p = 0.58). Conclusions: This meta-analysis strongly suggests that leave-on facial products, facial sunscreen and moisturizer, are associated with FFA. While the association with facial moisturizer did not persist when stratifying for female populations, gender sub-analyses remained significant for a facial sunscreen. There was no significant relationship found with hair products or treatments. These findings suggest a potential environmental etiology in the development of FFA, particularly UV-protecting chemicals. [ABSTRACT FROM AUTHOR]