Pioglitazone for Lichen Planopilaris
Lichen planopilaris or "LPP" is a type of scarring alopecia. Patients with LPP first develop symptoms like itching, burning or pain in the scalp and sometimes notice increased hair shedding. The hair loss in the rare disorder is permanent.
Current treatments for LPP include topical steroids and steroid injections as well as an array of oral medications (hydroxychloroquine, doxycyline, prednisone, cyclosporine, isotretinoin).
Drs Baibergenova and Walsh from the University of Toronto published a nice study looking at the use of the oral medication pioglitazone in the treatment of LPP. It's one of the largest studies exploring the use of this drug in LPP. This drug first caught the attention of dermatologists and hair specialists back in 2009 when US dermatologist Dr. Paradi Mirmirani and her colleague Dr Karnik showed that one patient with LPP had a remarkable improvement in his disease following the use of pioglitazone. Piolgitazone is an oral medication which is used in the treatment of type 2 diabetes. After publication of this report, many dermatologists starting prescribing the medication to treat LPP.
New study of LPP Treatment
Now, Drs. Bairbergenova and Walsh studied 24 patients with lichen planopilaris who were treated with this drug. Five of 24 patients had complete remission of their disease and some improvement was noted in over one half of patients. 13 % of patients had no benefit and another 17 % had to stop on account of side effects.
This drug highlights the benefit of this class of drugs in the treatment of lichen planopilaris and possibly other types of scarring alopecia. The challenge now is to figure out exactly how (and if) to prescribe the drug for lichen planopilaris now that pioglitazone has been shown to increase the risk of bladder cancer, and the Food and Drug Administration (FDA) has placed a warning on prescriptions of this drug. It remains unclear how we might intergrate pioglitazone into our current treatment protocols for LPP.
Baibergenova A and Walsh S. Use of pioglitazone in patients with lichen planopilaris. Journal of Cutaneous Medicine and Surgery 2012; March- April; 97-
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887