Lichen Planus Activity and Damage Index (LiPADI)–Creation of the Questionnaire

Abstract

Introduction: Lichen planus (LP) is a chronic autoimmune disease that affects skin, oral and genital mucosa, and other sites. Basic difficulties in assessment of LP are multitude of disease forms and diverse locations of lesions. Moreover, there is lack of objective and consolidated tool for assessment of disease severity and LP progression. Objective: The aim of the study was to develop a valid evaluation tool of LP severity, which will enable disease assessment in a repetitive way. Materials and methods: A combined tool called Lichen Planus Activity and Damage Index (LiPADI) was developed to assess the severity of LP skin, mucosal, and nail lesions as well as hair loss/scaring alopecia to provide an integrative scoring for LP activity and damage caused by the disease. Skin lesions were assessed in nine locations: scalp, face, chest, abdomen, back and buttocks, arms, hands, legs, and feet. The assessment of lesion activity included erythema, hypertrophy, and scaling, while the damage was reflected by the assessment of hyperpigmentation and scaring/atrophy. In addition, mucosal lesions, nail abnormalities, hair loss, and scarring alopecia were evaluated as well. LiPADI scoring was compared with quality of life assessed with the Dermatology Life Quality Index, EQ-5D calculator, pain and pruritus intensity assessed with the Numerical Rating Scale as well as with the patient and physician global assessment. Results: Our results show that LiPADI well reflects the LP patient’s clinical condition. The obtained results were in line with other indicators assessed. In addition, it was possible to evaluate patients with various forms and locations of LP, what indicates its versatility. Conclusions: LiPADI seems to be a useful tool for measurement the severity of the LP and its progress over time, which could help to monitor the effectiveness of the patients’ treatment.

Availability of a validated cutaneous lichen planus disease index: a systematic review

“…We identified 217 studies, of which three met inclusion criteria (Table 1): Lichen Planus Activity, Area, and Severity Index (LPAASI), Lichen Planus Severity Index (LPSI), and Lichen Planus Activity and Damage Index (LiPADI). [2][3][4] The LPAASI is a cutaneous LP scoring system with activity based on the resolution or appearance of new lesions within 6 weeks to 12 months. 2 Disease area is calculated using body surface area (BSA), whilst severity is based on lesion morphology.…”

“…The LiPADI is a lesional scoring system that encompasses all mucocutaneous manifestations of LP. 4 Disease activity is based on lesional erythema, hypertrophy, and scale of the largest lesion in nine cutaneous locations, mucosal involvement, and hair loss. Damage is assessed based on cutaneous hyperpigmentation and scarring, nail involvement, and scalp scarring.…”