Lichen Planus Clinical Trial Prescreening

1

Participants who qualify receive:

Study treatment at no cost
Compensation for their time and travel expenses
Uber transportation to and from study visits, if needed

2

Are you between 18 and 63 years old?* This field is required.

Yes

No

3

Have you been diagnosed with lichen planus, or do you believe you may have lichen planus?* This field is required.

Yes

No

Not sure

4

On a scale from 0–10, where 0 means no itch and 10 means the worst itch imaginable, how bad is your itching?

5

Scale (Do Not Delete)

6

Have you ever been treated with a JAK inhibitor, such as Rinvoq (upadacitinib), Xeljanz (tofacitinib), or ruxolitinib?* This field is required.

Yes

No

Not sure

7

Could you come to study visits about twice a month for the first few months, and then about once a month after that? The office is located at 📍 16100 NE 16th Ave, North Miami Beach, FL 33162* This field is required.

Yes

No

8

Calculation (DO NOT DELETE)

9

Thank you very much for participating in this survey. Based on your answers, we believe that you may be ineligible for this clinical trial. However, if you would like a staff member to contact you, please provide your best contact information below.

10

Full Name* This field is required.

First Name

Last Name

11

Email Address* This field is required.

example@example.com

12

Cell Phone Number* This field is required.

Please enter a valid phone number.

13

Best Time to Contact You* This field is required.