Comorbid conditions in lichen planopilaris: A retrospective data analysis of 334 patients

Abstract

BackgroundLichen planopilaris (LPP) is a rare, cicatricial, lymphocyte-mediated alopecia that is thought to have an autoimmune pathogenesis and possibly related to other autoimmune diseases. However, data are limited and studies that examine comorbid conditions are lacking.ObjectivesWe sought to determine the prevalence of systemic comorbid conditions, nutritional deficiencies, psychological problems, and skin cancers in patients with LPP.MethodsWe identified 334 patients with LPP who were seen in the Department of Dermatology at the Cleveland Clinic Foundation between 2000 and 2016. Patients with LPP were compared with 78 control patients with a diagnosis of seborrheic dermatitis.ResultsThere were more female patients with LPP compared with the controls (93.1% vs. 79.5%; p < .001) but the average age did not differ (54.77 ± 12.83 vs. 52.19 ± 15.37; p = .12). Conditions positively associated with LPP were Hashimoto’s thyroiditis (6.3% vs. 0%; p = .023), hypothyroidism (24.3% vs. 12.8%; p = .028), and hirsutism (11.4% vs. 1.3%; p = .006). Negatively associated conditions were allergic rhinitis (15% vs. 24.4%; p = .046), diabetes mellitus type II (11.7% vs. 21.8%; p = .019), hyperlipidemia (38.6% vs. 52.6%; p = .024), vitamin D deficiency (50% vs. 65.4%; p = .014), depression (15.6% vs. 28.9%; p = .018), and sleep problems (7.5% vs. 29.5%; p < .001).ConclusionsOur study further emphasizes that dermatologists should screen patients with LPP for autoimmune disorders that are associated with LPP and complete a full metabolic workup to avoid missing other abnormalities. The importance of atopy, autoimmune disorders, endocrine disorders, nutritional deficiencies, psychological problems, and skin cancers in patients with scarring alopecia should be better understood.

Compared to Controls, Individuals with Lichen Planopilaris Have More Depression, a Lower Self-Esteem, and a Lower Quality of Life

“…Accordingly, such information might have allowed a more thorough view of psychophysiological status of the participants. In this line, thirdly, Brankov et al [15] showed in their retrospective study that, compared to healthy controls, individuals with LPP had several further somatic complaints such as Hashimoto’s thyroiditis, hypothyroidism, hirsutism, allergic rhinitis, diabetes mellitus type II, hyperlipidemia, and vitamin D deficiency. Accordingly, it is conceivable that such data might have biased 2 or more dimensions in the same or opposite directions.…”

“…Complementarily, to explain the underlying pathophysiology of major depressive disorders, among others, major depressive disorders appear to be mediated by proinflammatory cytokines [34]. Fourthly, Brankov et al [15] observed higher sleep complaints in individuals with LPP compared to healthy controls. The association between poor sleep and higher psychological issues is well established [35], and therefore it is conceivable that poor sleep might have further negatively impacted the dimensions of depression and anxiety.…”

“…Further, Brankov et al [15] reported in their retrospective data analysis of 334 individuals with LPP higher prevalence rates of somatic comorbidities such as Hashimoto’s thyroiditis, hypothyroidism, hirsutism, allergic rhinitis, diabetes mellitus type II, hyperlipidemia, and vitamin D deficiency, always compared to healthy controls. Brankov et al [15] also reported higher scores of depression, anxiety, and sleep complaints, always compared to controls.…”

“…Brankov et al [15] also reported higher scores of depression, anxiety, and sleep complaints, always compared to controls.…”

“…Further, previous studies have shown that LPP is associated with more psychological issues. However, in the mentioned studies, we also observed some methodological issues such as coarse-grained yes-no items to assess depression, anxiety, and sleep complaints [15], the lack of a comparison group of healthy participants [14], and assessment of individuals with general PCA, including individuals with frontal fibrosing alopecia; however assessment of a sample with both PCA and frontal fibrosing alopecia might bear the risk of bias in the pattern of results [14]. To counter these limitations, the aims of the present study were to thoroughly assess dimensions of depression, anxiety, self-esteem, and quality of life among individuals with LPP.…”