Assessment Tool for Lichen Planopilaris in Trials

A new system for the grading and assessment of Lichen Planopilaris - including a form of scarring hair loss - has now started clinical trials.

Frontal Fibrosing Alopecia is a clinical variant of Lichen Planopilaris, which causes a thick band of hair loss around the hairline which leaves behind a pale, smooth band of skin; although it can present in men, it largely only affects women over 40 years of age.

Researchers at Massachusetts General Hospital, Boston, USA, have designed a new diagnostic test for Lichen Planopilaris and Frontal Fibrosing Alopecia, which is currently being trialled on 40 volunteers.

Measure severity over time

The observational study is assessing its Boston Grade of Activity in Lichen Planopilaris (Boston GOAL) tool over the course of six months. It hopes to prove that it is a valid, objective and accurate method which dermatologists and medical specialists can use when diagnosing and monitoring patients with the rare inflammation-based condition.

During the trial they will use the Boston GOAL tool to rate changes in participants' symptoms, including pain and itchiness, using a Numeric Rating Scale (NRS) and scores from the Dermatology Life Quality Index (DLQI).

The grades allocated using the trial tool will be correlated with patients' skin biopsies, which the study author notes will be "evaluating disease activity on a microscopic level", as well as with digital global photography and trichoscopy images.

According to data submitted via the registration information at clinicaltrials.gov, all of the participants - a mix of male and female - are between 18 and 80 years of age, with a clinical and histologic diagnosis of lichen planopilaris but otherwise in general good health.

It is estimated that this trial, which was first registered in 2017, should be completed by September 2019, with the study ending a few months later in December. As such, it is likely that findings will be made available at the very end of 2019 or in early 2020.

Dealing with Frontal Fibrosing Alopecia

The inflammation symptomatic of this autoimmune disease can destroy hair follicles, leaving them incapable of producing hair regrowth.

Currently, there is no authorised hair loss treatment for Frontal Fibrosing Alopecia. Due to the nature of the condition, hair restoration surgery is an unlikely possibility, though it depends on the extent of the condition and other factors, not least the skill of the individual hair transplant surgeon.

Treating Frontal Fibrosing Alopecia involves trying to manage the inflammation, rather than concentrating on encouraging hair growth. This is generally done via steroid use and/or anti-malarial drugs, as advised and prescribed by the patient's GP or dermatologist.

In addition to trying to address the underlying cause of this balding, patients may need emotional support in coping with the psychological effects of hair loss.

This is where peer support groups, hair loss charities and even counsellors or therapists can be useful, both in terms of providing advice and coping mechanisms, and to foster a feeling of community and inclusion, so that those with Frontal Fibrosing Alopecia are not isolated and have others with shared experiences to lean on.