Should patients with FFA and LPP avoid certain allergens?
Most patients with FFA and LPP won’t be allergic to any kind of fragrance or preservative. So the simple answer to the question asked above is – if one doesn’t have any clear evidence of having allergies then randomly avoiding potential allergens probably does not make much sense.
However, if a patient with FFA and LPP is found by their dermatologist to have a relevant allergy, then staying away from the specific allergen makes really good sense. Again, in many cases the only real way to prove someone is allergic to a specific chemical is to do patch testing.
In the study quoted above, allergen avoidance helped patients with FFA and LPP a great deal. Specifically, 58 % of patients with FFA and LPP who avoided the allergen that their doctors told them they needed to avoid had a reduction in scalp itching. Furthermore, 72.7 % of patients with FFA and LPP who avoided the allergen that their doctors told them they needed to avoid had a reduction in scalp redness too.
These are pretty significant numbers!
Summary and Conclusions
We are still int he early days of trying to figure out if allergens in a patient’s environment trigger their LPP or make the LPP they already have a bit worse. It’s seems possible.
It’s becoming clear that some patients with LPP and FFA will improve the way their scalp feels and looks if they stay away from certain allergens. This does not apply to everyone so unfortunately we don’t have any kind of all encompassing statement that applies to everyone with LPP and FFA.
For now, the following actions seem appropriate in my opinion:
1) All patients with LPP and FFA should at the very least have a discussion with their dermatologist about potential allergens they might be coming into contact with. Not everyone with FFA or LPP is going to be sent off to have ‘patch testing’ like the person in the photos above, but some will. Probably more patients wth FFA and LPP need to have patch testing than we are doing now. That’s easy for me to say because current rates are extremely low. But it’s certainly not everyone who needs to undergo patch testing.
2) Fragrance allergens seem pretty relevant for a good proportion of patients with FFA and LPP. Again it’s not everyone. Other allergens besides fragrance may be relevant for some patients with LPP and FFA so not everything is about fragrance. If someone has trouble getting their LPP under control and does not want to progress to stronger and stronger medications and can not undergo patch testing for whatever reason, it makes sense to try a hypoallergenic shampoo. May of these can be purchased from the internet:
Hypoallergnic shampoos include the following:
Vanicream Free and Clear
AFM Safe Choice
SEEN shampoo (Fragrance Free version)
Prasad et al. Patch testing and contact allergen avoidance in patients with lichen planopilaris and/or frontal fibrosing alopecia: A cohort study. J Am AcadDermatol 2020; 83: 659-661.
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