What are the treatment options for lichen planopilaris?

From the Guidelines

Lichen planopilaris treatment should begin with high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05% cream or ointment, or tacrolimus 0.1% ointment, as recommended by the NCCN guidelines 1. When considering treatment options for lichen planopilaris, it's essential to prioritize topical therapies due to their favorable safety profile and effectiveness.

• High-potency topical steroids are recommended for all grades of lichen planus and lichenoid diseases, including lichen planopilaris.
• The choice of formulation, such as cream, ointment, or solution, depends on the affected area, with solutions being suitable for scalp disease.
• Additional treatment options, such as oral antihistamines, prednisone, and narrow-band UVB phototherapy, may be considered for more severe cases or when topical therapies are insufficient 1. Key considerations in treating lichen planopilaris include:
• Regular follow-up to monitor treatment response and adjust therapy as needed
• The potential use of oral medications, such as prednisone, for acute flares or more severe disease
• The importance of suppressing the inflammatory immune response that damages hair follicles, as lichen planopilaris is an autoimmune condition causing scarring hair loss.

From the Research

Treatment Options for Lichen Planopilaris

The treatment options for lichen planopilaris (LPP) include:

• Topical/intralesional steroids and orally administered hydroxychloroquine, which is the most utilized option 2
• Low-level light therapy (LLLT), which has shown to be effective in reducing inflammation, disappearing symptoms, and promoting hair regrowth with no side effects 2
• Oral cyclosporine, which has been successful in treating severe and refractory lichen planus of the skin and has produced sustained remission in some patients 3
• High-potency topical corticosteroids, which are first-line therapy for all forms of lichen planus, including cutaneous, genital, and mucosal erosive lesions 4
• Systemic corticosteroids, which should be considered for severe, widespread lichen planus involving oral, cutaneous, or genital sites 4
• Platelet-rich plasma (PRP), which has been reported to arrest the development of LPP and promote complete regression of itching and hair shedding 5
• Topical tacrolimus, which appears to be an effective treatment for vulvovaginal lichen planus 4
• Acitretin, an oral retinoid, or an oral immunosuppressant, which may be considered for patients with severe lichen planus that does not respond to topical treatment 4

Goals of Treatment

The main goals of treatment for LPP are:

• Reducing symptoms 6
• Preventing disease progression 6
• Preventing further hair loss 6

Response to Therapy

The response to therapy for LPP can be varied, with frequent reports of poor response 6