80 % of Patients May have some Response to Hydroxychloroquine for LPP

Combination of Hydroxychloroquine and Clobetasol Helps 80 % - but only 20 % Halt their Disease Completely.

Authors of a new study set out to retrospectively evaluate the benefits of hydroxychlroquine and clobetasol in treating lichen planopilaris (LPP). They included fifteen patients (86% females and 13.4% males; mean age 58.4±13.65 years) with LPP in their retrospective study. All were treated with HCQ 200-400 mg/day for ≥16 weeks and topical clobetasol 0.05%, two times a week. The median time of treatment was 12 months.

Evaluation of CR, PR and TF

In this study, the authors defined what they meant by complete response, partial response and treatment failure.

a) Complete clinical response (CR) was defined as no reported symptoms, no hair loss progression, and noevidence of ongoing disease activity (erythema and perifollicular hyperkeratosis)

b) Partial clinical response (PR) as clinical improvement, with evidence of ongoing activity

c) Treatment failure (TF) as ongoing activity and hair loss progression.

Results

There were no adverse events. Three patients obtained CR (20%), eight PR (53.3%), one stayed stable (6.6%), and three patients TF (20%).

Perifollicular scale was among the most important trichoscopic features to improve. At baseline, 60% of the patients (N=9) presented severe perifollicular scale, while at the end of the study, only 13% (N=2).

Conclusions

This is a valuable study. It’s challenging to know how to define treatment success in scarring alopecia. Treatment success becomes clearer and clearer after 2,3 and 4 years and sometimes is a bit more difficult in the short term. A patient may have redness but no hair loss as therefore is said to have a partial response. Overall, about 80% of patients have some kind of benefit with hydroxychlroquine and clobetasol. For 20 % of patients, this may be enough and no further treatment is needed. For another proportion of patients, some additional treatments may be needed in order to fully halt the disease.

These data overall are similar to other studies of hydroxychloroquine in treating LPP.

a) Chiang et al 2010.

In 2010 Chiang et al conducted retrospective chart review of 40 adult patients with LPP, and/or FFA who were treated with hydroxychloroquine for up to 12 months from 2004 to 2007. The authors found that there was significant reduction in the LPPAI at both 6 and 12 months. After 6 months, 69% had reduced symptoms and signs ( a reduction in the LPPAI). At 12 months, 83% had improvement (reduction) in symptoms and signs.

b) Dhonncha EN et al. 2017

In 2017, Dhonncha et al evaluated the benefits of hydroxychloroquine in 23 patients with LPP. 61 % had a complete response and 9 % had a partial response.

Reference

Maria Vastarella et al. Efficacy and safety of hydroxychloroquine for the management of lichen planopilaris in a real-life setting. Ital J Dermatol Venerol. 2022 Jun;157(3):296-297.

Chiang C et al. Hydroxychloroquine and lichen planopilaris: efficacy and introduction of Lichen Planopilaris Activity Index scoring system. J Am Acad Dermatol. 2010 Mar;62(3):387-92.

Dhonncha EN et al. The role of hydroxychloroquine in the treatment of lichen planopilaris: A retrospective case series and review. Dermatol Ther. 2017 May;30(3).