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<p>Lichen Planopilaris (LPP) can cause permanent hair loss; however, evidence regarding its presentation and management in skin of color (SOC) remains limited. This study aims to investigate diagnostic challenges, clinical patterns, treatment responses, and outcomes of LPP across different Fitzpatrick skin types, emphasizing patients with SOC. A retrospective cohort study of 160 LPP patients (80 Fitzpatrick I-III; 80 Fitzpatrick IV-VI) at a tertiary dermatology center from January 2015 to January 2025. The primary outcomes and measures included time to diagnosis, trichoscopy findings, histopathological features, treatment response (as measured by the Lichen Planopilaris Activity Index [LPPAI] score reduction), and quality of life assessments. Patients with Fitzpatrick types IV-VI experienced 3.2-fold significantly longer diagnostic delays (7.1 vs. 2.2 months, <i>P</i> &lt; 0.001) than those with types I-III. Atypical trichoscopic patterns were observed in 68% of SOC patients, compared to 14% in patients with lighter skin types. The use of chemical relaxers and tension-based hairstyles was associated with higher disease severity. Combined intralesional corticosteroids with calcineurin inhibitors achieved comparable response rates across all skin types (74.6% vs. 71.2%, <i>P</i> = 0.61). Significant differences exist in diagnostic timelines and clinical presentations of LPP in SOC. These findings support the need for further investigation into specialized diagnostic approaches and culturally informed management strategies for diverse patient populations.</p>

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Phenotypic diversity of lichen planopilaris in skin of color: diagnostic challenges and clinical outcomes in a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2025年10月11日

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  • Khaled Seetan,
  • Almu’atasim Khamees,
  • Raghad Yousef Yassin,
  • Nada Faheem Zayed,
  • Saleh A. Ba-shammakh,
  • Amir Majdi Moh’d,
  • Khayry Al-Shami

摘要

Lichen Planopilaris (LPP) can cause permanent hair loss; however, evidence regarding its presentation and management in skin of color (SOC) remains limited. This study aims to investigate diagnostic challenges, clinical patterns, treatment responses, and outcomes of LPP across different Fitzpatrick skin types, emphasizing patients with SOC. A retrospective cohort study of 160 LPP patients (80 Fitzpatrick I-III; 80 Fitzpatrick IV-VI) at a tertiary dermatology center from January 2015 to January 2025. The primary outcomes and measures included time to diagnosis, trichoscopy findings, histopathological features, treatment response (as measured by the Lichen Planopilaris Activity Index [LPPAI] score reduction), and quality of life assessments. Patients with Fitzpatrick types IV-VI experienced 3.2-fold significantly longer diagnostic delays (7.1 vs. 2.2 months, P < 0.001) than those with types I-III. Atypical trichoscopic patterns were observed in 68% of SOC patients, compared to 14% in patients with lighter skin types. The use of chemical relaxers and tension-based hairstyles was associated with higher disease severity. Combined intralesional corticosteroids with calcineurin inhibitors achieved comparable response rates across all skin types (74.6% vs. 71.2%, P = 0.61). Significant differences exist in diagnostic timelines and clinical presentations of LPP in SOC. These findings support the need for further investigation into specialized diagnostic approaches and culturally informed management strategies for diverse patient populations.