Lichen planopilaris: retrospective study on the characteristics and treatment of 291 patients

Lichen planopilaris (LPP) is an immune-mediated cicatricial alopecia. The main clinical presentations of LPP include classic form, frontal fibrosing alopecia (FFA), and Graham-Little-Piccardi-Lassueur syndrome (GLPLS). We reviewed medical records of all 291 patients diagnosied with LPP from 2006 to 2017 in Department of Dermatology, Tehran University of Medical Sciences. LPP was more common in women than men. Lichen planus (LP) was seen in 59 of patients (20.3%). Parietal lesions (69.75%), frontal (27.14%), occipital (23.71%), and temporal (21.64%) were frequently seen in LPP patients. However, trunk hair involvement (15.4% vs. 2.7%; p = .011) and eyebrow involvement (57.7% vs. 0%; p < .0001) were high in FFA patients. The response rates of cyclosporine (CSP) and methotrexate (MTX) were highest, 100% and 85%, respectively. Those treated with CSP achieved partial remission (PR) and complete remission (CR) faster than MTX-treated group. Moreover, MTX was more effective than MMF but not different in time to reach PR (p = .23) or CR (p = .56). However, CSP and MTX were less safe compared with MMF. 5-alpha reductase inhibitors, systemic retinoids (isotretinoin) or their combination were the most effective therapeutic options for FFA patients.