Apremilast (Otezla) for Refractory Lichen Planopilaris and Frontal Fibrosing Alopecia

Apremilast May be Option For LPP and FFA

Otezla is a medication which targets a pathway inside cells known as the PDE4 pathway. It is typically used to treat a skin disease known as psoriasis but may occasionally be used for other reasons as well.

In 2017, Professor Lebwohl and his group reported on 4 female patients with lichen planopilaris (LPP) or frontal fibrosing alopecia (FFA). These patients had been on other treatments such as steroid injections, hydroxychloroquine (Plaquenil) minocycline, aciitretin, mycophenolate mofetil and yet proceed to have benefit with Aprimelast.

Patients in this study were started on fairly high doses of Apremilast to start. However, all 4 had improvement in symptoms. The exact means of improvement is not well detailed in the research paper. We do not know for example if the LPPAI (Lichen planoopilaris activity index) was reduced nor do we know if the results were maintained long term. 2 of the 4 patients stopped the drug due to side effects which are outlined in the table. 3 of the four patients had gastrointestinal side effects.

COMMENT

This was an interesting paper outlining a novel therapy in the treatment of LPP and FFA. We don’t know for sure if the patients in the study had FFA or LPP or both but presumably 3 had LPP and 1 had FFA (patient 3).

Further large scale studies are needed regarding the use of Apremilast in treating LPP and FFA but these are investing findings that may guide further studies.

Apremilast is also expensive. A 30 day supply of the 30 mg twice daily dose costs about $ 1500 Canadian dollars ($1200 USD). The drug may not be covered by all insurance plans given that it is completely off label for treating LPP and FFA.

Download: Apremilast (Otezla) Handout for our Patients

REFERENCE

Hadi, A., & Lebwohl, M. (2017). Apremilast for Lichen Planopilaris and Frontal Fibrosing Alopecia: A Case Series. SKIN The Journal of Cutaneous Medicine, 1(1), 32-36. https://doi.org/10.25251/skin.1.1.5