443 Lichen planopilaris and frontal fibrosing alopecia: A possible link with rosacea

Abstract

Lichen planopilaris (LPP) and its clinical variant, frontal fibrosing alopecia (FFA), are primary cicatricial alopecias. The etiopathogenesis remains unknown, however the 2 conditions primarily affect post-menopausal, Caucasian women. An increased incidence of rosacea has been identified in this patient cohort, with rates of 34-62% in FFA1,2 compared to 1.5-10% in the general European population3. In this cross-sectional cohort study, we evaluate the incidence, subtype, and severity of rosacea in 66 patients presenting for evaluation of LPP/FFA. 77% (51/66) of patients were found to have rosacea on exam. 42% classified as mild, 34% as moderate and 2% as severe. Among LPP patients, 72% were found to have erythematotelangiectatic (ET) subtype with 30% ocular involvement. In FFA patients, 62% were found to have ET subtype, 21% papulopustular, and 27% with ocular involvement. The prevalence of LPP and FFA has steadily increased over the last decade, with several genetic, biologic, and environmental factors proposed. However, association with rosacea may provide new insight into the pathogenesis. A shared neurogenic inflammation (NI) mechanism may explain erythema, burning, immune infiltration, and skin fibrosis. Substance P and calcitonin gene-related peptide have been identified as possible NI mediators in rosacea with more recent implications in scarring hair loss4. Further understanding of this increased co-occurrence may promote early intervention and improve treatment options.