Quality of Life in LPP and FFA: Using the LPP Activity Index does not Help

How should We be Measuring Quality of LIfe in LPP and FFA?

Evaluating quality of life in patients with various types of hair loss is important. Treatment needs to not only address hair loss but ensure quality of life is addressed.

A recent study by Doche and colleagues looked at whether the activity of lichen planopilaris and frontal fibrosing alopecia correlates with quality of life.

This study included 10 patients with LPP and 27 with FFA. Patients were administered the Dermatology Life Quality Index (DLQI) questionnaire and had their disease activity measured in clinic by use of the lichen planopilaris activity index (LPPAI).

There were 33 females and 4 males, all skin types. Mean age was 58.8 and mean disease duration was 40.3 months.

The authors found that the total DLQI scores were not related to LPPAI scores in a simple linear regression model (P = 0.35).

Conclusions

This is an interesting study that reminds us that the “activity” of the LPP does not necessarily correlated well with the quality of life.

The LPPAI is a good measure for LPP activity but it’s not really a good measure for FFA. Nevertheless it’s a good rough estimate.

We clearly need better measures to evaluate patient quality of life in scarring alopecia.

The LPPAI has many limitations when it comes to looking at quality of life. The first limitation is that the LPPAI does not evaluate amount of hair loss. A person could have low LPPAI scores suggesting the disease is quiet but have almost no hair loss at all. A second person could have low LPPAI and be nearly bald.

The second limitation is the LPPAI is a poor measure for FFA activity (in my opinion). The pull test is often negative in FFA and the area to look for perifollciular ertyema and scale matters. Furthermore, the disease progression is slower so it can be hard to pick up changes with each visit.

We clearly need measures that allow us to understand how FFA and LPP patients are affected by their disease. The authors nicely point out in this study that 8 % of LPP patients had ‘non scalp lesions” compared to 59 % of FFA patients. It’s likely that these non scalp issues that are more prevalent in FFA have a big impact on quality of life. These might include eyebrow loss, facial papules, pigmentation changes, eyelash loss, adn limb hair loss. All these are more common in FFA than LPP.

New measures will need to take into account:

a) more emphasis on symptoms

b) more emphasis on eyebrow and eyelash loss

c) more emphasis on facial vein presence

d) more emphasis on facial papules.

e) more emphasis on the amount of hair loss and ability to disguise.

f) more emphasis on oral or vaginal lichen planus

g) more emphasis on LP pigmenotosum and pigmentation changes in the skin.

REcent studies in alopecia areata have taught us that eyebrow and eyelash loss are really improtant. An important measure of quality of life in alopecia areata is the way patient feels about their hair. It could be improtant to simply ask patients through structured questionnaires how they feel about their hair loss.

REFERENCE

Doche I et al. Quality-of-life impairment is not related to disease activity in lichen planopilaris and frontal fibrosing alopecia. Results of a preliminary cross-sectional study. J Eur Acad Dermatol Venereol . 2022 Apr;36(4):e288-e290.