Clinical Insights and Prognostic Factors in Frontal Fibrosing Alopecia and Lichen Planopilaris: A Retrospective Cohort Study.

INTRODUCTION

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) share histopathology but differ in clinical presentation, disease course, and treatment patterns. This study aimed to compare clinical characteristics, treatments, outcomes, and prognostic factors between LPP and FFA.

METHODS

A retrospective cohort study was conducted at Sheba Medical Center, Israel (2010-2023). Patients with LPP or FFA followed for ≥1 year were included. Remission was categorized as early (≤12 months) or late (>12 months).

RESULTS

A total of 141 patients were included (81 LPP, 60 FFA). FFA showed greater female predominance (96.7% vs. 80.2%, p = 0.004), older age at presentation (56.9 ± 12.2 vs. 49.1 ± 14.1 years, p = 0.0008) and higher postmenopausal proportion (81.8% vs. 44.4%, p = 0.004). LPP patients more frequently reported pain (50.6% vs. 6.7%) and pruritus (82.7% vs. 36.7%) (both p < 0.00001). Cumulative remission was higher in FFA than in LPP (68.3% vs. 45.7%, p = 0.022), whereas early remission rates and time to remission were similar (22.8 ± 17.6 vs. 22.9 ± 20.5 months, p = 0.98). Relapse rates were similar during treatment (22.0% vs. 16.2%, p = 0.59) and after discontinuation (29.3% vs. 27.0%, p = 0.83). Early remission was predicted by mild baseline severity in LPP (OR: 4.24), and by rural residence (OR: 7.00) and statin use (OR: 3.85) in FFA; tetracycline treatment was inversely associated (OR: 0.21). For late remission in LPP, older age at first visit was positively associated (OR: 1.06/year), whereas Ashkenazi Jewish ethnicity was inversely associated (OR: 0.33).

CONCLUSION

FFA had higher cumulative remission than LPP despite similar time to remission and relapse rates, with distinct remission predictors.