Jeffrey Cohen, MD: Understanding Pathways, Treatments for Lichenoid Dermatoses

In this interview with Jeffrey Cohen, MD, of the Yale School of Medicine, Cohen spoke with the HCPLive editorial team about his talk given at the 2024 American Academy of Dermatology (AAD) Annual Meeting.

Cohen’s presentation, titled ‘Knowing Lichenoid Dermatoses: Common Pathways and Treatments,’ primarily covered the conditions of lichen planus and lichen planopilaris.

“Lichen planus is a skin and also mucosal disease that is typified by very pruritic, often described as polygonal, purple papules,” Cohen explained. “They come very frequently in the flexors so on the wrists and ankles, but it can be much more generalized and some patients have very widespread lichen planus.”

Following this discussion, Cohen moved onto the topic of llichen planopilaris, a hair condition which can be described as a scarring alopecia and is known to involve a lichenoid infiltrate seen under the microscope.

“Lots of T-cells come around the hair follicles and that causes the hair to be lost and then, unfortunately, scarring to occur, so that hair can never be regrown,” Cohen said. “So it is a condition that we want to move on quickly when we see it in order to avoid irreversible hair loss in areas of the scalp.”

Cohen referenced his presentation’s content related to comorbidities of these conditions, especially highlighting some of the newer examples.

“There are some comorbidities of lichen planus that we've known for a while: hepatitis C, high lipids in the blood, hyperlipidemia,” Cohen said. “But over the last several years, a lot of work has been done to try to learn about some new comorbidities. Some of the emerging comorbidities that we reviewed were cardiovascular disease…rheumatoid arthritis, lupus, depression, anxiety. And on the lichen planopilaris front, there is less known and less epidemiology work done. But some similar comorbidities have emerged in that disorder as well.”

Cohen commented on 1 particularly unique element of the talk, touching on the fact that a lot of the underlying pathophysiology of some of these comorbidities links well with some of the pathophysiology that is being explored in lichen planus and lichen planopilaris.

“It makes sense that some of the inflammation that's occurring in the skin or the mucosa, or the scalp, is contributing to a systemic inflammatory state that may be leading to some of these comorbidities that we see in this patient population,” Cohen said. “It was also noted that it's important to understand these comorbidities and be aware of these comorbidities to allow us as dermatologists to have knowledge that would allow us to pick up on some of these comorbidities early and allow patients to be treated for them appropriately as they come up.”

To learn more about the conference takeaways, view the full discussion posted above.

The quotes included in this summary were edited for the purposes of clarity.