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Tekin B, Xie F, Lehman JS. Lichen Planus: What is New in Diagnosis and Treatment? Am J Clin Dermatol 2024:10.1007/s40257-024-00878-9. [PMID: 38982032 DOI: 10.1007/s40257-024-00878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/11/2024]
Abstract
Lichen planus (LP), an idiopathic, multifaceted chronic inflammatory disease with a heterogeneous clinical presentation, affects approximately 0.5-1% of the population. The various clinical manifestations of LP fall into three broad categories, namely cutaneous, appendageal, and mucosal, with further subclassification depending on the morphology and distribution patterns of individual lesions. There is mounting evidence that LP has systemic associations, including autoimmune conditions, glucose intolerance, dyslipidemia, and cardiovascular disorders. Cutaneous hypertrophic and mucosal forms of LP are at a heightened risk for malignant transformation. Familiarity with these potential associations in conjunction with long-term follow-up and regular screening could lead to a timely diagnosis and management of concomitant conditions. In addition, the frequent quality of life (QoL) impairment in LP underscores the need for a comprehensive approach including psychological evaluation and support. Several treatment strategies have been attempted, though most of them have not been adopted in clinical practice because of suboptimal benefit-to-risk ratios or lack of evidence. More recent studies toward pathogenesis-driven treatments have identified Janus kinase inhibitors such as tofacitinib, phosphodiesterase-4 inhibitors such as apremilast, and biologics targeting the interleukin-23/interleukin-17 pathway as novel therapeutic options, resulting in a dramatic change of the treatment landscape of LP. This contemporary review focuses on the diagnosis and management of LP, and places emphasis on more recently described targeted treatment options.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Dermatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Julia S Lehman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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2
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Roman AM, Petca RC, Dumitrașcu MC, Petca A, Ionescu (Miron) AI, Șandru F. Frontal Fibrosing Alopecia and Reproductive Health: Assessing the Role of Sex Hormones in Disease Development. J Pers Med 2024; 14:72. [PMID: 38248773 PMCID: PMC10817300 DOI: 10.3390/jpm14010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Frontal Fibrosing Alopecia (FFA) is a distinctive form of cicatricial alopecia characterized by gradual hairline recession, predominantly affecting postmenopausal individuals, thus implying a potential hormonal origin. This narrative review, spanning 2000 to 2023, delves into PubMed literature, focusing on the menopausal and hormonal status of women with FFA. The objective is to unravel the intricate nature of FFA and its plausible associations with hormonal dysregulations in women. While menopause remains a pivotal demographic characteristic linked to FFA, existing data suggest that its hormonal imbalances may not fully account for the development of FFA. Conversely, substantial evidence indicates a strong association between a reduction in fertile years, particularly through surgical interventions leading to an abrupt hormonal imbalance, and FFA in women. Additionally, exposure to hormone replacement therapy or oral contraceptives has shown varying degrees of association with FFA. Gynecologists should maintain a heightened awareness regarding the ramifications of their interventions and their pivotal role in overseeing women's fertility, recognizing the potential influence on the progression of FFA. The recurrent theme of hormonal disruption strongly implies a causal connection between alterations in sex hormones and FFA in women. Nevertheless, this relationship's extent and underlying mechanisms remain subjects of ongoing debate.
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Affiliation(s)
- Alexandra-Maria Roman
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania; (A.-M.R.); (F.Ș.)
| | - Răzvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Mihai Cristian Dumitrașcu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Obstetrics and Gynecology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Andreea-Iuliana Ionescu (Miron)
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Medical Oncology, Colțea Clinical Hospital, 030167 Bucharest, Romania
| | - Florica Șandru
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania; (A.-M.R.); (F.Ș.)
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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3
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Rayinda T, McSweeney SM, Fenton D, Stefanato CM, Harries M, Palamaras I, Tidman A, Holmes S, Koutalopoulou A, Ardern-Jones M, Williams G, Papanikou S, Chasapi V, Vañó-Galvan S, Saceda-Corralo D, Melián-Olivera A, Azcarraga-Llobet C, Lobato-Berezo A, Bustamante M, Sunyer J, Starace MVR, Piraccini BM, Wiss IP, Senna MM, Singh R, Hilmann K, Kanti-Schmidt V, Blume-Peytavi U, Simpson M, McGrath JA, Dand N, Tziotzios C. Shared Genetic Risk Variants in Both Male and Female Frontal Fibrosing Alopecia. J Invest Dermatol 2023; 143:2311-2314.e5. [PMID: 37211199 DOI: 10.1016/j.jid.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/04/2023] [Accepted: 04/22/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Tuntas Rayinda
- St John's Institute of Dermatology, School of Basic & Medical Sciences, King's College London, London, United Kingdom; Department of Dermatology and Venereology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sheila M McSweeney
- St John's Institute of Dermatology, School of Basic & Medical Sciences, King's College London, London, United Kingdom
| | - David Fenton
- St John's Institute of Dermatology, School of Basic & Medical Sciences, King's College London, London, United Kingdom
| | - Catherine M Stefanato
- St John's Institute of Dermatology, School of Basic & Medical Sciences, King's College London, London, United Kingdom
| | - Matthew Harries
- Centre for Dermatology Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ioulios Palamaras
- Barnet and Chase Farm Hospitals, Royal Free NHS Foundation Trust, London, United Kingdom
| | - Alice Tidman
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Susan Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Anastasia Koutalopoulou
- Department of Dermatology, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Michael Ardern-Jones
- Department of Dermatology, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - Sofia Papanikou
- Department of Dermatology and Venereology of NHS, Andreas Syggros Hospital of Skin and Venereal Diseases, Athens, Greece
| | - Vasiliki Chasapi
- Department of Dermatology and Venereology of NHS, Andreas Syggros Hospital of Skin and Venereal Diseases, Athens, Greece
| | - Sergio Vañó-Galvan
- Trichology Unit, Dermatology Department, Ramon Y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
| | - David Saceda-Corralo
- Trichology Unit, Dermatology Department, Ramon Y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
| | - Ana Melián-Olivera
- Trichology Unit, Dermatology Department, Ramon Y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
| | - Carlos Azcarraga-Llobet
- Trichology Unit, Dermatology Department, Ramon Y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
| | | | | | - Jordi Sunyer
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Michela Valeria Rita Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Isabel Pupo Wiss
- Harvard Medical School and Lahey Hospital and Medical Center, Boston, Massachusetts
| | | | - Rashmi Singh
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kathrin Hilmann
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Varvara Kanti-Schmidt
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Dermatology, Venerology, Allergology and Phlebology, Johannes Wesling Medical Centre, University Hospital of the Ruhr University of Bochum, Minden, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Simpson
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
| | - John A McGrath
- St John's Institute of Dermatology, School of Basic & Medical Sciences, King's College London, London, United Kingdom
| | - Nick Dand
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
| | - Christos Tziotzios
- St John's Institute of Dermatology, School of Basic & Medical Sciences, King's College London, London, United Kingdom.
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Kam O, Na S, Guo W, Tejeda CI, Kaufmann T. Frontal fibrosing alopecia and personal care product use: a systematic review and meta-analysis. Arch Dermatol Res 2023; 315:2313-2331. [PMID: 37014396 DOI: 10.1007/s00403-023-02604-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is a cicatricial alopecia affecting the frontotemporal hairline. Given that this scarring, immune-mediated follicular destruction most commonly affects postmenopausal Caucasian women, researchers have postulated that there are hormonal and genetic components; however, the etiology of FFA is still unknown. Recently, dermatologists have reported cases of FFA as being potentially caused by cosmetic products, such as sunscreen and shampoo. Therefore, this systematic review and meta-analysis intend to be the first to analyze the relationship between FFA and cosmetic/personal care products and treatments, including sunscreen, moisturizer, foundation, shampoo, conditioner, hair mousse, hair gel, hair dye, hair straightening/rebonding, chemical/laser facial resurfacing, aftershave, and facial cleanser. METHODS The Cochrane, PubMed, EMBASE, and Medline (Ovid) databases were searched for the relevant studies from the date of inception to August 2022. Case-control, cross-sectional, and cohort studies examining the effects of cosmetic/personal care product use on FFA, available in English full-text, were included. Analyses were performed using Review Manager, version 5.4. Results were reported as an odds ratio (OR) with a 95% confidence interval (CI); p values < 0.05 were considered significant. RESULTS Nine studies were included in our quantitative analyses, totaling 1,248 FFA patients and 1,459 controls. There were significant positive associations found for FFA and sunscreen (OR 3.02, 95% CI 1.67-5.47; p = 0.0003) and facial moisturizer (OR 2.20, 95% CI 1.51-3.20; p < 0.0001) use. Gender sub-analyses demonstrated a positive association for FFA and facial moisturizer in men (OR 5.07, 95% CI 1.40-18.32; p = 0.01), but not in women (OR 1.58, 95% CI 0.83-2.98; p = 0.16). Both gender sub-analyses were significantly positive for the association with facial sunscreen (Male OR 4.61, 95% CI 1.54-13.78, p = 0.006; Female OR 2.74, 95% CI 1.32-5.70, p = 0.007). There was no association found for a facial cleanser (OR 1.14, 95% CI 0.33-1.52; p = 0.51), foundation (OR 1.13, 95% CI 0.83-1.55; p = 0.21), shampoo (OR 0.49, 95% CI 0.22-1.10; p = 0.08), hair conditioner (OR 0.81, 95% CI 0.52-1.26; p = 0.35), hair mousse (OR 1.37, 95% CI 0.75-2.51; p = 0.31), and hair gel (OR 0.90, 95% CI 0.48-1.69; p = 0.74), hair dye (OR 1.07, 95% CI 0.69-1.64; p = 0.77), hair straightening/rebonding (OR 0.88, 95% CI 0.08-9.32; p = 0.92), hair perming (OR 1.41, 95% CI 0.89-2.23; p = 0.14), facial toner (OR 0.51, 95% CI 0.12-2.21; p = 0.37), or aftershave (OR 1.64, 95% CI 0.28-9.49; p = 0.58). CONCLUSIONS This meta-analysis strongly suggests that leave-on facial products, facial sunscreen and moisturizer, are associated with FFA. While the association with facial moisturizer did not persist when stratifying for female populations, gender sub-analyses remained significant for a facial sunscreen. There was no significant relationship found with hair products or treatments. These findings suggest a potential environmental etiology in the development of FFA, particularly UV-protecting chemicals.
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Affiliation(s)
- Olivia Kam
- Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA.
| | - Sean Na
- Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - William Guo
- Department of Dermatology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Christina I Tejeda
- Department of Dermatology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Tara Kaufmann
- Department of Dermatology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
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5
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Pathoulas JT, Flanagan KE, Walker CJ, Collins MS, Ali S, Pupo Wiss IM, Cotsarelis G, Milbar H, Huang K, Mostaghimi A, Scott D, Han JJ, Lee KJ, Hordinsky MK, Farah RS, Bellefeuille G, Raymond O, Bergfeld W, Ranasinghe G, Shapiro J, Lo Sicco KI, Gutierrez D, Ko J, Mirmirani P, Mesinkovska N, Yale KL, Goldberg LJ, Tosti A, Gwillim EC, Goh C, Senna MM. A multicenter descriptive analysis of 270 men with frontal fibrosing alopecia and lichen planopilaris in the United States. J Am Acad Dermatol 2023; 88:937-939. [PMID: 36396001 DOI: 10.1016/j.jaad.2022.10.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/25/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Affiliation(s)
- James T Pathoulas
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kelly E Flanagan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Chloe J Walker
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Maya S Collins
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shaheir Ali
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Isabel M Pupo Wiss
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - George Cotsarelis
- Department of Dermatology, University of Pennsylvania, Pennsylvania, Pennsylvania
| | - Heather Milbar
- Department of Dermatology, University of Pennsylvania, Pennsylvania, Pennsylvania
| | - Kathie Huang
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Deborah Scott
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jane J Han
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Karen J Lee
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Maria K Hordinsky
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ronda S Farah
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Gretchen Bellefeuille
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ora Raymond
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Wilma Bergfeld
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | | | - Jerry Shapiro
- Department of Dermatology, NYU Langone Health, New York, New York
| | | | - Daniel Gutierrez
- Department of Dermatology, NYU Langone Health, New York, New York
| | - Justin Ko
- Department of Dermatology, Stanford University, Palo Alto, California
| | - Paradi Mirmirani
- Department of Dermatology, Kaiser Permanente Vallejo Medical Center, Vallejo, California
| | - Natasha Mesinkovska
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Katerina L Yale
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Lynne J Goldberg
- Department of Dermatology, Boston University Medical Center, Boston, Massachusetts
| | - Antonella Tosti
- Department of Dermatology, University of Miami Health System, Miami, Florida
| | - Eran C Gwillim
- Department of Dermatology, University of Miami Health System, Miami, Florida
| | - Carolyn Goh
- Department of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Maryanne M Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Karim N, Mirmirani P, Durbin-Johnson BP, Rocke DM, Salemi M, Phinney BS, Rice RH. Protein profiling of forehead epidermal corneocytes distinguishes frontal fibrosing from androgenetic alopecia. PLoS One 2023; 18:e0283619. [PMID: 37000833 PMCID: PMC10065298 DOI: 10.1371/journal.pone.0283619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
Protein profiling offers an effective approach to characterizing how far epidermis departs from normal in disease states. The present pilot investigation tested the hypothesis that protein expression in epidermal corneocytes is perturbed in the forehead of subjects exhibiting frontal fibrosing alopecia. To this end, samples were collected by tape stripping from subjects diagnosed with this condition and compared to those from asymptomatic control subjects and from those exhibiting androgenetic alopecia. Unlike the latter, which exhibited only 3 proteins significantly different from controls in expression level, forehead samples from frontal fibrosing alopecia subjects displayed 72 proteins significantly different from controls, nearly two-thirds having lower expression. The results demonstrate frontal fibrosing alopecia exhibits altered corneocyte protein expression in epidermis beyond the scalp, indicative of a systemic condition. They also provide a basis for quantitative measures of departure from normal by assaying forehead epidermis, useful in monitoring response to treatment while avoiding invasive biopsy.
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Affiliation(s)
- Noreen Karim
- Department of Environmental Toxicology, University of California, Davis, California, United States of America
| | - Paradi Mirmirani
- Department of Dermatology, The Permanente Medical Group, Vallejo, California, United States of America
| | - Blythe P. Durbin-Johnson
- Department of Public Health Sciences, Division of Biostatistics, Clinical and Translational Science Center Biostatistics Core, University of California, Davis, California, United States of America
| | - David M. Rocke
- Department of Public Health Sciences, Division of Biostatistics, Clinical and Translational Science Center Biostatistics Core, University of California, Davis, California, United States of America
| | - Michelle Salemi
- Proteomics Core Facility, University of California, Davis, California, United States of America
| | - Brett S. Phinney
- Proteomics Core Facility, University of California, Davis, California, United States of America
| | - Robert H. Rice
- Department of Environmental Toxicology, University of California, Davis, California, United States of America
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