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Lichen Planopilaris in Women

A Retrospective Review of 232 Women Seen at Mayo Clinic From 1992 to 2016

      Abstract

      Objective

      To characterize the clinicopathologic findings, comorbidities, and treatment outcomes of women with lichen planopilaris (LPP).

      Method

      In this retrospective review of women with LPP at Mayo Clinic from 1992 to 2016, we searched for scarring alopecia in all female patients aged 1 to 100 years from January 1, 1992, through December 31, 2016. Men were excluded from this study to more accurately determine the association of hormonal factors in LPP pathogenesis. Two hundred thirty-two patients were included as they met diagnostic criteria for LPP based on clinicopathologic correlation, with 217 having confirmatory biopsies.

      Results

      We identified 232 women with LPP (mean age, 59.8 years). Of those, 92.7% (215) presented with hair loss; 23.7% (55) had preceding inflammation; 30.6% (71) had thyroid disease, including hypothyroidism (23.2%; 54); and 9.4% (22) had vitamin D deficiency. Incidence of depression and anxiety was 45.7% (106) and 41.8% (97), respectively. History of total abdominal hysterectomy/bilateral salpingo-oophorectomies and hormone replacement therapy was found in 16.8% (39) and 16.4% (38), respectively. Lichen planus at other body sites occurred in 16.4% (38) of patients; and 53.2% (123) had slowing of disease progression or disease stabilization, often requiring combination therapies. In those who achieved slowing or stabilization of disease, mean time to recurrence was 1.8 year. The mean time to remission was 1.1 year.

      Conclusion

      The typical LPP patient is a 60-year-old female with vertex scarring alopecia who presents with burning, erythema, inflammation, and scale. Almost half of patients will have comorbid autoimmunity. As previously reported, LPP is associated with thyroid disease. We also found higher rates of depression, anxiety, nutritional deficiencies, and skin cancer than reported in the general population.

      Abbreviations and Acronyms:

      BCC (basal cell carcinoma), BSO (bilateral salpingo-oophorectomy), CD (Crohn disease), CPC (clinicopathologic correlation), DS (disease stabilization), FFA (frontal fibrosing alopecia), HRT (hormone replacement therapy), LP (lichen planus), LPP (lichen planopilaris), NOS (not otherwise specified), RA (rheumatoid arthritis), SCC (squamous cell carcinoma), SDP (slowing of disease progression), SLE (systemic lupus erythematous), SS (Sjögren syndrome), TAH (total abdominal hysterectomy), UC (ulcerative colitis), UDP (unaltered disease progression)
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