LPPAI Calculator

Lichen Planopilaris Activity Index — Chiang, Sah, Cho, Ochoa & Price, 2010

Purpose
Composite measure of disease activity in lichen planopilaris (and frontal fibrosing alopecia) combining patient symptoms, clinical signs, a positive anagen pull test and spreading, to monitor response to treatment.
Population
Adults with lichen planopilaris or its variants (frontal fibrosing alopecia, Graham-Little syndrome). Scored by physical examination, without trichoscopy.
Formula
LPPAI = (pruritus + pain + burning)/3 + (scalp erythema + perifollicular erythema + perifollicular scale)/3 + 2.5 × (pull test) + 1.5 × (spreading/2)  ·  Range 0–10
Severity thresholds
No validated severity cut-offs. LPPAI is a change score: Chiang 2010 compared values before and after treatment (higher = more active). Report the trend over time.
💬 Symptoms (patient-reported)

Grade each symptom as reported by the patient over the recent period.

0 Absent 1 Mild 2 Moderate 3 Severe
Symptom component (sum / 3) 0.00
🔍 Clinical signs

Grade each sign on clinical examination of the affected scalp.

0 Absent 1 Mild 2 Moderate 3 Severe
Sign component (sum / 3) 0.00
✋ Pull test and spreading

0 = no anagen hairs · 1 = any anagen hairs. In scarring alopecia the pull test is considered positive when anagen hairs are obtained.

Spreading (progression of hair loss reported by the patient)

0 = no · 1 = uncertain · 2 = yes. Contributes 1.5 × (spreading / 2) → 0, 0.75 or 1.5 points.

📚 References
  1. Chiang C, Sah D, Cho BK, Ochoa BE, Price VH. Hydroxychloroquine and lichen planopilaris: efficacy and introduction of Lichen Planopilaris Activity Index scoring system. J Am Acad Dermatol. 2010;62(3):387–92. doi:10.1016/j.jaad.2009.08.054
  2. Saceda-Corralo D, Moreno-Arrones ÓM, Fonda-Pascual P, et al. Development and validation of the Frontal Fibrosing Alopecia Severity Score. J Am Acad Dermatol. 2018;78(3):522–9. doi:10.1016/j.jaad.2017.09.034
  3. Errichetti E, Figini M, Croatto M, Stinco G. Therapeutic management of classic lichen planopilaris: a systematic review. Clin Cosmet Investig Dermatol. 2018;11:91–102. doi:10.2147/CCID.S137870
  4. Svigos K, Yin L, Fried L, Lo Sicco K, Shapiro J. A practical approach to the diagnosis and management of classic lichen planopilaris. Am J Clin Dermatol. 2021;22(5):681–92. doi:10.1007/s40257-021-00630-7
Clinical decision support only. This tool is intended to assist clinical assessment and does not replace professional judgment. Always interpret results in the context of the individual patient.