Department of Dermatology, Northwell Health, New Hyde Park, New York.
Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Hempstead, New York.
JAMA Dermatol. 2024 Aug 1;160(8):865-868. doi: 10.1001/jamadermatol.2024.1445.
Lichen planopilaris (LPP) is a form of scarring alopecia associated with progressive, permanent hair loss. Symptoms range from burning pain to itching, also carrying substantial psychological morbidity. Yet, disease characteristics, pathophysiology, and effective treatment data are limited, making treatment a challenge.
To describe the prevalence and dermatologist-prescribed treatment patterns of LPP among US adults.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the Explorys database. The prevalence analysis used a 15% random sample and identified US adults with LPP diagnoses between 2017 and 2019. The LPP treatment analysis included all patients with LPP diagnoses between 2016 and 2020 and a dermatologist encounter in the first year after diagnosis. Data were analyzed from January 2023 to April 2023.
The main outcomes of the prevalence analysis were the crude and standardized prevalence estimates of US adults with LPP across age, sex, and racial groups. The main outcomes of the treatment analysis were the frequency of LPP treatments within 1 year of diagnosis, and the number of patients who continued treatment beyond 1 year, switched treatments, and combined treatments.
Among 1 466 832 eligible patients analyzed for prevalence, 241 patients had an LPP diagnosis (222 [92.1%] female; median [IQR] age, 64 [54-73] years). Standardized overall prevalence was 13.4 per 100 000 (95% CI, 11.7-15.1). In the treatment analysis, 991 patients had an LPP diagnosis (907 [91.5%] female; median (IQR) age, 60 [47-69] years). Most received at least 1 type of medication (635 [64.1%]), most frequently intralesional corticosteroids (370 [37.3%]) and topical corticosteroids (342 [34.5%]), followed by doxycycline (104 [10.5%]) and hydroxychloroquine (72 [7.3%]). Treatment continued beyond 1 year in 71 of 200 patients (35.5%) prescribed intralesional corticosteroids and 7 of 29 patients (24.1%) prescribed hydroxychloroquine. Treatment switching at 1 year occurred in 32 of 254 patients (12.6%) first prescribed an intralesional corticosteroid and in 44 of 194 (22.7%) first prescribed a topical corticosteroid. Combinations of 2 or 3 treatment types were given to 137 (13.8%) and 74 (7.5%) patients, respectively.
This cross-sectional study reported prevalence and treatment patterns for US adults with LPP in a representative sample. Most patients with LPP received treatment, and many received multiple treatment types and switched treatments, suggesting further research into medication selection offers clinical benefit.
扁平苔藓性瘢痕性脱发 (LPP) 是一种与进行性、永久性脱发相关的瘢痕性脱发。症状范围从灼痛到瘙痒不等，还伴有严重的心理发病。然而，疾病特征、病理生理学和有效治疗数据有限，使治疗成为一个挑战。
描述美国成年人中 LPP 的患病率和皮肤科医生开具的治疗模式。
设计、设置和参与者：这是一项使用 Explorys 数据库的横断面研究。患病率分析使用了 15%的随机样本，并确定了 2017 年至 2019 年间患有 LPP 诊断的美国成年人。LPP 治疗分析包括 2016 年至 2020 年间所有患有 LPP 诊断的患者，以及诊断后第一年的皮肤科医生就诊。数据于 2023 年 1 月至 2023 年 4 月进行分析。
患病率分析的主要结果是 LPP 患者在年龄、性别和种族群体中的粗患病率和标准化患病率估计。治疗分析的主要结果是诊断后 1 年内 LPP 治疗的频率，以及继续治疗超过 1 年、更换治疗、联合治疗的患者数量。
在分析的 1466832 名符合条件的患者中，有 241 名患者患有 LPP 诊断（222 名 [92.1%] 为女性；中位 [IQR] 年龄为 64 [54-73] 岁）。总体标准化患病率为每 10 万人 13.4 例（95%CI，11.7-15.1）。在治疗分析中，有 991 名患者患有 LPP 诊断（907 名 [91.5%] 为女性；中位 [IQR] 年龄为 60 [47-69] 岁）。大多数患者至少接受了 1 种药物治疗（635 名 [64.1%]），最常接受的是皮损内皮质类固醇（370 名 [37.3%]）和外用皮质类固醇（342 名 [34.5%]），其次是多西环素（104 名 [10.5%]）和羟氯喹（72 名 [7.3%]）。在 200 名接受皮损内皮质类固醇治疗的患者中，有 71 名（35.5%）和 29 名接受羟氯喹治疗的患者（24.1%）继续治疗超过 1 年。在首次接受皮损内皮质类固醇治疗的 254 名患者中有 32 名（12.6%）和首次接受外用皮质类固醇治疗的 194 名患者中有 44 名（22.7%）发生了治疗转换。137 名（13.8%）和 74 名（7.5%）患者分别接受了 2 种或 3 种治疗类型的联合治疗。
这项横断面研究报告了代表性样本中美国成年人 LPP 的患病率和治疗模式。大多数患有 LPP 的患者接受了治疗，许多患者接受了多种治疗类型并更换了治疗方法，这表明进一步研究药物选择可以带来临床益处。
