Treatment of Lichen Planopilaris and Frontal Fibrosing Alopecia: A Retrospective, Real-Life Analysis in a Tertiary Center in Germany
Abstract
:1. Introduction
1.1. Lichen Planopilaris
1.2. Frontal Fibrosing Alopecia
2. Patients and Methods
2.1. Patient Population
2.2. Clinical Outcomes
2.3. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Topical Treatment
3.3. Systemic Treatment
3.4. Response to Hydroxychloroquine and Symptom Relief Is Associated with Treatment Duration
3.5. Renewed Exacerbation of Clinical Symptoms after Discontinuation of System Treatment Is Associated with Time on Systemic Treatment
3.6. Discontinuation of Treatment Was More Likely in Patients Who Experienced Adverse Events
3.7. Duration of Response and Second-Line Treatment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Baseline Characteristics | |
---|---|
Clinicopathological Features | N (%) |
Total number of patients | 110 |
Median age at diagnosis | 56 (range 23–81) |
Gender | |
Female | 92 (84%) |
Male | 18 (16%) |
Diagnosis | |
Lichen planopilaris (LPP) | 85 (77%) |
Frontal fibrosing alopecia (FFA) | 25 (23%) |
Location of hair loss at presentation | |
Frontal | 31 (28%) |
Temporal | 12 (11%) |
Parietal | 70 (63%) |
Eyebrows | 9 (8%) |
Clinical findings on presentation | |
Hair loss | 110 (100%) |
Perifolicular erythema | 42 (38%) |
Follicular hyperkeratosis or plugging | 39 (35%) |
Scaling or atrophy | 105 (95%) |
Pruritus | 92 (84%) |
Eyebrow loss | 22 (20%) |
Laboratory findings | |
Haemoglobin median | 13.7 g/dL (range 11.2–16.9) |
Leukocytes median | 6.3/nL (range 3.4–13.3) |
Thrombocytes median | 234/nL (range 33–371) |
Low TSH serum levels | 11 (10%) |
Elevated Aspartate Aminotransferase (AST/GOT) serum levels | 9 (8%) |
Elevated Alanine Aminotransferase (ALT/GPT) serum levels | 8 (7%) |
Elevated Gamma-glutamyltransferase (yGT) serum levels | 8 (7%) |
Co-morbidities | |
Autoimmune disease | 28 (25%) |
Hashimoto thyroiditis | 24 (86% of patients with AI disease) |
Rheumatoid arthritis | 4 (14% of patients with AI disease) |
First-Line Treatment | N (%) |
---|---|
Topical | 101 (92% of all patients) |
Glucocorticoids III/IV | 101 (92%) |
Calcineurin inhibitors | 24 (22%) |
Outcome | |
Responder | 15 (13%) |
Non-responder | 95 (87%) |
Systemic | 77 (70%) |
Hydroxychloroquine 200 mg | 68 (88% of systemic Tx) |
Retinoide (Acitretin 20 mg) | 2 (3%) |
Ciclosporine A (5 mg/kg) | 7 (9%) |
All patients received an additional topical treatment with mild cortisteroid or topical calicneurin inhibitors * | 77 (105) |
Outcome | |
Responders | 48 (63%) |
Hydroxychloroquine | 42 (62% of systemic Tx) |
Retinoide | 1 (50%) |
Ciclosporine A | 5 (71%) |
Non-responders | 29 (38%) |
Hydroxychloroquine | 26 (38%) |
Retinoide | 1 (50%) |
Ciclosporine A | 2 (29%) |
Clinical response | |
Reduction of hair loss | 47 (97% of responders) |
Reduction of perifolicular erythema | 14 (29%) |
Reduction of follicular hyperkeratosis | 36 (75%) |
Reduction of pruritus | 41 (85%) |
Duration of treatment | |
Median treatment duration in months (range) | 12 (range 1–60) |
Hydroxychloroquine | 17.3 |
Retinoides | 8.5 |
Ciclosporine | 17.9 |
Ongoing treatment | 19 (25%) |
Adverse events leading to cessation of treatment | 17 (22%) |
Acquired secondary resistance | 11 (14%) |
Cessation of therapy due to stable disease | 30 (38%) |
Progress after discontinuation | 17/58 (29%) |
Second-Line Treatment | N (%) |
---|---|
Second-line therapy | 13 |
Hydroxychloroquine | 4 (32%) |
Methotrexate | 2 (15%) |
Ciclosporine A | 6 (46%) |
Systemic glucocorticoid | 1 (7%) |
Outcome | |
Responders | |
Hydroxychloroquine | 4 (100%) |
Ciclosporine A | 4 (66%) |
Methotrexate | 1 (50%) |
Systemic glucocorticoid | 1 (100%) |
Methotrexate | 1 (50%) |
Median treatment duration (range) | 14 (range 4–96) |
Ongoing treatment | 4 (31%) |
Cessation of therapy due to stable disease | 6 (55%) |
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Stege, H.; Haist, M.; Schultheis, M.; Pawlowski, J.; Wittmann, M.; Grabbe, S.; Butsch, F. Treatment of Lichen Planopilaris and Frontal Fibrosing Alopecia: A Retrospective, Real-Life Analysis in a Tertiary Center in Germany. J. Clin. Med. 2024, 13, 4947. https://doi.org/10.3390/jcm13164947
Stege H, Haist M, Schultheis M, Pawlowski J, Wittmann M, Grabbe S, Butsch F. Treatment of Lichen Planopilaris and Frontal Fibrosing Alopecia: A Retrospective, Real-Life Analysis in a Tertiary Center in Germany. Journal of Clinical Medicine. 2024; 13(16):4947. https://doi.org/10.3390/jcm13164947
Chicago/Turabian StyleStege, Henner, Maximilian Haist, Michael Schultheis, Johannes Pawlowski, Miriam Wittmann, Stephan Grabbe, and Florian Butsch. 2024. "Treatment of Lichen Planopilaris and Frontal Fibrosing Alopecia: A Retrospective, Real-Life Analysis in a Tertiary Center in Germany" Journal of Clinical Medicine 13, no. 16: 4947. https://doi.org/10.3390/jcm13164947