Frontal fibrosing alopecia and lichen planopilaris: epidemiology, treatment, and remission rate (2014-2024)

Frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) are cicatricial alopecia with overlapping but distinct epidemiological, clinical, and therapeutic features. This study evaluates their epidemiological and clinical characteristics, treatment approaches, and one-year remission rates. This retrospective cohort study was conducted at Holy Family Hospital, Karachi, Pakistan. Data from electronic records included demographics, clinical presentations, histology, treatments, outcomes, and follow-up. Patients of all ages and genders diagnosed with LPP or FFA between January 2014 and December 2024, with a minimum one-year follow-up, were included. LPP patients had a higher mean age at onset (53.1±9.42 years) than FFA patients (45.8±10.4 years; p=0.02). Scalp involvement was more common in LPP (95.9%), while body involvement was higher in FFA (85.7%; p<0.001). FFA patients had more symptoms, whereas LPP was often asymptomatic (p<0.001). Remission rates were similar at 12 months, but FFA showed higher long-term remission (59.0% vs. 39.0%; p=0.004). FFA patients sustained remission (55.7% vs. 23.4%; p<0.001), while LPP had more partial or no responses. This study highlighted key differences in demographics, clinical features, and treatments between FFA and LPP, with similarities in diagnostic delays and treatment approaches. Variations were noted in the age of onset, symptoms, clinical presentation, and outcomes.