442 Frontal fibrosing alopecia: Utilization of the Lichen Planopilaris Activity Index to assess treatment outcomes

Abstract

Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia which affects the frontotemporal scalp and face. The etiology of FFA is thought to be related to environmental exposures and a genetic susceptibility. FFA is considered to be a relatively new disease; there is a paucity of knowledge surrounding its pathogenesis, treatment and prognosis. Because FFA is histologically similar to lichen planopilaris (LPP), we chose to characterize long-term outcomes of our FFA patients using the LPP Activity Index (LPPAI), a validated scoring system introduced in 2010 which combines symptoms, signs and progression. We used this tool to assess longitudinally (0 and 12 months) the efficacy of treatments in our hair disease clinics. We completed a retrospective chart review of patients with a diagnosis of FFA seen by one investigator (MH) from 7/1/09-6/30/19. Clinical data and patient demographics were extracted from the electronic medical record Epic by the University of Minnesota Best Practices Integrated Informatics Core yielding 706 patients diagnosed with lichen planus, LPP and/or FFA. A further keyword search, with the terms frontal fibrosing alopecia or FFA, was performed using a natural language processing program, identifying 142 patients. This patient population was then limited to 24 patients due to availability of LPPAI data. A paired sample t-test was performed to evaluate differences between LPPAI scores at the baseline visit and the 12-month visit. Our analyses revealed that our patient population is predominantly female, white, and postmenopausal. Additionally, FFA patients achieved a statistically significant reduction in LPPAI score after 12 months of treatment; however, no patients were found to have a complete absence of symptoms or signs. In conclusion, the LPPAI is a valuable tool which can provide a standardized method to quantify clinical progression and response to therapy.