Medical comorbidities in patients with lichen planopilaris,
a retrospective case–control study
Raymond M. Fertig
, Shasa Hu
, Austin J. Maddy
, Alexandra Balaban
, Nouf Aleid
, Adam Aldahan
, and Antonella Tosti
Department of Dermatology and
Cutaneous Surgery, Miller School of
Medicine, University of Miami, Miami, FL,
Department of Dermatology,
Prince Sultan Military Medical City, Riyadh,
Raymond M. Fertig,
1475 NW 12th Ave, 2nd Floor
Miami, FL 33136,
Conﬂicts of interest: Dr. Antonella Tosti
discloses the following: P&G, Consultant;
DS Laboratories, Consultant; Incyte, PI;
Taylor & Francis, Author-Royalties; Karger,
Editor in chief; National Alopecia Areata
Foundation, Scientiﬁc Board. The remaining
authors declare no disclosures.
Background Lichen planopilaris (LPP) is a rare inﬂammatory lymphocyte-mediated
disease of the scalp considered to have an autoimmune pathogenesis.
Objectives To identify the prevalence of medical comorbidities in patients with classic LPP
(CLPP) and frontal ﬁbrosing alopecia (FFA).
Methods The medical records of 206 LPP patients and 323 control patients were
retrospectively reviewed for existing comorbidities. The control group consisted of 257
patients with androgenetic alopecia (ICD 9 = 704.0 or ICD 10 = L64.9) and 66 patients
with actinic keratosis (ICD 9 = 702.0 or ICD 10 = L57.0).
Results Systemic lupus erythematosus (SLE) was found in 4.37% of all patients with LPP
(including CLPP and the FFA subtype) and in 0.31% of controls. Female patients with the
FFA subtype were more likely to have SLE than controls (OR 31.034, 95% CI 2.405–
400.382, P = 0.0085).
Limitations This study is limited in that it is a retrospective chart review.
Conclusion Female patients with FFA are signiﬁcantly more likely to have SLE. Patients
with LPP (including CLPP and the FFA subtype) are less likely to have diabetes. Patients
with CLPP excluding FFA are less likely to have hypertension, heart disease, and
Lichen planopilaris (LPP), a follicular subtype of lichen planus, is
the most common cause of scarring alopecia.
It presents with
chronic scalp inﬂammation and scaling, leading to atrophic
patches of permanent alopecia. It is a disease of unknown etiol-
ogy, although it is generally considered to have an autoimmune
pathogenesis. However, few studies have found signiﬁcant, clear,
or speciﬁc associations and comorbidities with the disease.
Recent studies have observed an association of LPP with
thyroid disease, especially hypothyroidism,
with the FFA sub-
type experiencing signiﬁcantly more thyroid dysfunction than the
In addition, studies have investigated the associa-
tion of LPP with lichen planus, seborrheic dermatitis, vitiligo,
and diabetes mellitus.
The purpose of our study is to evaluate the prevalence of
comorbidities in patients with LPP. We hypothesized that
patients with LPP were more likely to have other autoimmune
conditions based on the general understanding of the etiology
of LPP as an autoimmune disease. The patients in this study
were seen at an academic dermatology clinic that serves as a
tertiary referral center for hair and nail diseases. All of the LPP
patients were seen by one attending physician. The study popu-
lation includes the largest LPP cohort to date.
Materials and methods
After receiving Institutional Review Board approval (IRB
#20160538), the medical records of 206 LPP patients and 323
control patients were retrospectively reviewed for existing
comorbidities. The case subjects included all LPP subtypes,
both classic LPP (CLPP) and frontal ﬁbrosing alopecia (FFA).
No case subjects had Graham-Little-Piccardi-Lassueur
syndrome. The control group consisted of 257 patients with
androgenetic alopecia (AA) (International Classiﬁcation of
Diseases [ICD] 9 = 704.0 and ICD 10 = L64.9) and 66 patients
with actinic keratosis (AK) (ICD 9 = 702.0 and ICD 10 = L57.0).
We selected 2 groups of controls: one group of patients with
non-LPP hair disorder, and another group of patients without
hair disorder but with a common dermatological diagnosis. Our
International Journal of Dermatology 2018, 57, 804–809 ª 2018 The International Society of Dermatology