Advances in Dermatology and Allergology
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eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
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2/2026
vol. 43
 
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abstract:
Original paper

Stress: an important cofactor in patients with lichen planopilaris and frontal fibrosing alopecia

Anna Waśkiel-Burnat
1
,
Michela Starace
2, 3
,
Federico Quadrelli
2, 3
,
Daniel Asz Sigall
4
,
Katarzyna Pisarz
1
,
Nkechi Enechukwu
5
,
Adriana Rakowska
1
,
Marta Kurzeja
1
,
Bianca Maria Piraccini
6
,
Lidia Rudnicka
1

  1. Department of Dermatology, Medical University of Warsaw, Poland
  2. Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
  3. Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
  4. Trichology Clinic, Hospital General "Dr Manuel Gea Gonzalez", Mexico City, Mexico
  5. Dermatology Unit, Department of Internal Medicine, Nnamdi Azikiwe University, Nnewi, Anambra State, Nigeria
  6. Private Dermatology Practice, Bologna, Italy
Adv Dermatol Allergol 2026; XLIII (2): 185–190
DOI: https://doi.org/10.5114/ada.2026.161197
Online publish date: 2026/04/22
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Introduction
It has been shown that patients with hair loss may experience reduced confidence, increased self-consciousness, and low self-esteem. However, data concerning patients with lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) remain limited.

Aim
The aim of the study was to assess the quality of life and psychological status of patients with LPP and FFA.

Material and methods
In 83 patients with LPP and 79 patients with FFA, we assessed the health-related quality of life, disease perception, depression, anxiety and stress using dedicated questionnaires: DLQI, IPQ-B and DASS-21.

Results
In 34% (28/83) of patients with LPP and 19% (15/79) of patients with FFA, the disease had at least a moderate effect on the patient’s quality of life. In patients with LPP and FFA, positive correlations were observed between the DLQI and LPPAI (r = 0.406, p < 0.001 and r = 0.317, p < 0.01, respectively). Moderate or high threat was experienced by 59% (49/83) of patients with LPP and 61% (48/79) of patients with FFA. A moderate or severe stress level was noted in 42% (35/83) and 31% (24/79) of patients with LPP and FFA, respectively. In 29% (25/83) of patients with LPP and 20% (17/79) of patients with FFA, at least a mild depression level was observed. Only 10% (8/83) of patients with LPP reported a mild or moderate anxiety level. Stress was considered as the most common cause of the disease by 42% (35/83) of patients with LPP and 42% (33/79) of patients with FFA.

Conclusions
Patients with LPP and FFA may experience a substantial impairment of the quality of life and stress, which, in their opinion, is a cause of their condition.

keywords:

depression, hair loss, quality of life, psychological distress, scarring alopecia

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