Study Highlights Prevalence of Lichen Planopilaris, Patterns in Treatment in the US

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Most US adults with lichen planopilaris (LPP) were given treatment, according to new findings, though many were treated with multiple medications and had switched treatments. This indicated that additional studies looking at selection of treatment could offers greater insights.¹

These findings and others represented the conclusion of new research into the reported trends in prevalence and patterns of treatment for lichen planopilaris. This research was led by Natalia Pelet del Toro, MD, from the department of dermatology at Northwell Health in New Hyde Park, New York.

The investigators acknowledged the decreases in quality of life commonly seen with lichen planopilaris, a morphological variant of lichen planus which leads to inflammation-driven destruction of hair follicles and subsequent scarring, tenderness, itch, and burning.

“Robust epidemiologic and pathophysiologic data are limited with no evidence-based approved treatments,” del Toro and colleagues wrote. “Our objective was to estimate the prevalence of LPP in the US health care–seeking population and assess dermatologist-prescribed treatment patterns.”²

Background and Methods

The investigators used a cross-sectional study design, looking at data drawn from the Explorys database. Explorys contains over 40 healthcare networks’ electronic medical records and de-identified information on 53 million individuals in the US.

The research team’s data analysis occurred from January 2023 - April 2023. In their prevalence analysis, the team used a random sampling of 15% of all individuals included, finding those with lichen planopilaris through the use of at least a single recorded ICD-10 code on or before the end of December 2019. A positive predictive value of 87.8% for the diagnostic methods for identifying lichen planopilaris implemented here was observed in a separate validation study.

A complete sample of subjects with diagnoses of lichen planopilaris were used from Explorys, with the investigators determining their criteria for Inclusion as a new diagnosis of the skin condition occurring between April 2016 - January 2020. Also, they required at least a single dermatology visit associated with the skin condition within the initial year following patients’ diagnoses.

The research team defined treatment switching, combination treatments, and treatment continuation. The team found that a Northwell Health validation study indicated that a single lichen planopilaris code noted by a clinician had a positive predictive value of 93.0%.

The team’s analysis of their data was performed using R, version 3.6.3, with statistical significance having been determined using 2-tailed, unpaired tests, as well as an alpha level of < .05.

Findings

Overall, the investigators included a total of 241 patients with lichen planopilaris out of a possible 1,466,832 eligible individuals. They noted that 92.1% of those included were female and there was a median age of 64 years.

The research team found that the crude prevalence of the skin condition was 16.4 per 100,000 (95% CI, 14.5-18.6). After adjusting the data for subjects’ age and sex, the team noted that overall prevalence had been 13.4 per 100,000 (95% CI, 11.7-15.1), with females showing a higher age-standardized prevalence versus males (22.7 per 100,000 [95% CI, 19.7-25.7] vs 2.9 per 100,000 [95% CI, 1.6-4.3]).

They also found the highest prevalence to be observed in those within the age bracket of 70-79 years (25.8 per 100,000).

There were 991 individuals who had been given dermatology visits connected to lichen planopilaris observed within the database, with 91.5% being female and the median age being 60 years. They added that 64.1% of these subjects were given at least a single type of treatment, mainly intralesional corticosteroids (ILC) for 37.3% and topical corticosteroids (TCS) for 34.5%.

Oral doxycycline (10.5%) was another treatment observed by the investigators, as was hydroxychloroquine (7.3%). Among those less-frequently prescribed, the research team identified systemic immunosuppressants (1.1%), 5-α reductase inhibitors (2.3%), and pioglitazone (0.3%), adding that no subjects had been qualified for JAK inhibitor use.

A notable finding was that many subjects (39.9%) had been shown to be given a single type of medication within the initial year following their diagnosis, though 13.8% and 7.5% were given 2 or 3 forms of treatments, respectively. Medication continuation was noted by the team as mostly occurring among subjects given ILC (35.5% with single-year follow-up) or hydroxychloroquine (24.1% with single-year follow-up).

Among the other findings, the investigators found that the highest rates of treatment switching to alternative or combination therapies within a year had been observed among individuals initially prescribed hydroxychloroquine (7 of 10), systemic immunosuppressants (1 of 3), systemic steroids (8 of 18), and oral doxycycline (7 of 20).

Switches in treatment seen within a single year were seen in 12.6% of the subjects initially on ILC. The team added that they were seen among 22.7% of those initially on TCS.

“The limitations of this study included missing data and potential miscoding,” they wrote. “The study period was limited by LPP lacking an ICD-10 code until late 2015 and health care disruptions due to the COVID-19 pandemic. Prevalence in the health care–seeking population may be overestimations in the general population.”

References

1. ^{Pelet del Toro N, Strunk A, Garg A, Han G. Prevalence and Treatment Patterns in Patients With Lichen Planopilaris. JAMA Dermatol. Published online June 12, 2024. doi:10.1001/jamadermatol.2024.1445.}
2. ^{Nasimi M, Ahangari N, Lajevardi V, Mahmoudi H, Ghodsi SZ, Etesami I. Quality of life and mental health status in patients with lichen planopilaris based on Dermatology Life Quality Index and General Health Questionnaire-28 questionnaires. Int J Womens Dermatol. 2020;6(5):399-403. doi:10.1016/j.ijwd.2020.09.005.}