Pruritus in Lichen Planopilaris and Frontal Fibrosing Alopecia—Clinical Characteristics and Dermoscopic Correlations

TL;DR

This study explores how itching relates to specific skin features in two types of scarring hair loss, LPP and FFA.

Contribution

The study identifies correlations between pruritus and specific dermoscopic features in LPP and FFA patients.

Findings

Itching occurred in 73.8% of patients with LPP and FFA.

Perifollicular scaling, hair diameter diversity, and white halo were significantly linked to pruritus.

Cold water and air often relieved itching, while heat and stress worsened it.

Abstract

Background: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are the most common causes of lymphocytic scarring alopecia. Itching of the scalp is a common accompanying symptom. The aim of the study was the clinical assessment of pruritus and its correlation with dermoscopic features. Methods: Sixty-one patients with scarring alopecia were analyzed (LPP = 16; FFA = 33; coexisting LPP-FFA = 12). Each patient underwent a trichoscopic examination. Itch severity and characteristics were assessed using a Visual Analogue Scale (VAS), 4-item Itch Questionnaire and 12-item Descriptive Pruritus Assessment Questionnaire. Results: Itching of the scalp occurred in 73.8% of the patients (mean maximal VAS 5.3 ± 3.1 points). Pruritus was most frequently accompanied by tingling (19.7%) or burning (14.8%) sensations. The following factors most frequently increased the severity of pruritus: sweating, heat, stress and hot water. On the other hand, cold water and cold air often relieved symptoms. There was a significant relationship between itch and perifollicular scaling (p = 0.011), hair diameter diversity (p = 0.008) and white halo (p = 0.016). Conclusions: Pruritus was the main subjective complaint reported by patients suffering from LPP and FFA. A better understanding of pruritic features may help in the selection of an effective therapeutic strategy.

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