Treatment challenges for lichen planopilaris

 

SYDNEY – Responses to treatments for lichen planopilaris varied widely, and decreased with second- and third-line therapies, in a retrospective study, Karolina Kerkemeyer, MD, said at the annual meeting of the Australasian College of Dermatologists.

An analysis of computerized medical records for 32 patients who had been treated for lichen planopilaris at a tertiary referral hair center in Australia was conducted from 2012 to 2016 by Dr. Kerkemeyer of the University of Notre Dame Australia, Werribee, and Jack Green, MD, of the Skin and Cancer Foundation and St. Vincent’s Hospital in Melbourne. The study excluded patients with a dual diagnosis, or those followed for less than 12 months.

The mean age of the patients was about 60 years; 29 were female. “Although there was only a small number of men affected with the disease, the men do seem to have a significantly earlier age of onset than women,” which has been previously reported, said Dr. Kerkemeyer. The researchers also noted that there was generally a delay in presenting to the clinic, with a mean interval of 4.9 years between disease onset and presentation.

The most common treatment was topical steroids, used to treat 31 patients, followed by tetracyclines – minocycline or doxycycline – used to treat 21 patients, and hydroxychloroquine, used to treat 18 patients. Some patients were also treated with steroid-sparing immunosuppressants, including methotrexate, mycophenolate, and cyclosporine. Fourteen patients were also treated with intralesional steroids, and seven were treated with topical tacrolimus.

The researchers used a graded four-point scale to assess patients’ response to treatment, which corresponded to remission, partial improvement, no change, and worsening of disease, based on patients’ clinical signs, symptoms, and extent of alopecia.

Only a small proportion – about 15% – of patients achieved remission, which was seen with topical steroids, hydroxychloroquine, and doxycycline. About one-third of patients treated with doxycycline actually showed a worsening of symptoms.

The greatest proportion (75%) of patients with partial remission was among those treated with systemic acitretin, although the numbers were low (three of four patients who received this therapy).

In addition, one of the seven patients treated with minocycline achieved partial remission during this therapy, one showed a worsening of the condition, and the remaining five were unchanged. Among those treated with an immunosuppressant, the 3 patients treated with mycophenolate had no change in the condition; 4 of the 10 patients treated with methotrexate achieved partial remission, 4 were unchanged, and 2 experienced a worsening of the condition. One of the three patients treated with cyclosporine achieved partial remission while the other two remained unchanged. With topical tacrolimus, two patients achieved partial remission, two showed a worsening of the condition, and the remaining three were unchanged.

The response rates to treatment significantly decreased with subsequent therapies: 18 of the 32 patients responded to first-line treatments, compared with 7 of 19 who received second-line treatment and only 1 of 9 patients who received third-line treatment. “Many patients were not responsive to therapy, highlighting the difficulty of treating this scarring alopecia,” Dr. Kerkemeyer said.

In an interview, she said that topical or intralesional steroids seemed to be the best first-line option because they are associated with fewer side effects than other options. “They were easier to start off in patients first,” and for those who do not respond, switching to another treatment, such as topical tacrolimus, if they wanted a topical option, or an oral treatment, such as an immunosuppressant like methotrexate, she noted.

No conflicts of interest were declared.

[email protected]

 

SYDNEY – Responses to treatments for lichen planopilaris varied widely, and decreased with second- and third-line therapies, in a retrospective study, Karolina Kerkemeyer, MD, said at the annual meeting of the Australasian College of Dermatologists.

An analysis of computerized medical records for 32 patients who had been treated for lichen planopilaris at a tertiary referral hair center in Australia was conducted from 2012 to 2016 by Dr. Kerkemeyer of the University of Notre Dame Australia, Werribee, and Jack Green, MD, of the Skin and Cancer Foundation and St. Vincent’s Hospital in Melbourne. The study excluded patients with a dual diagnosis, or those followed for less than 12 months.

The mean age of the patients was about 60 years; 29 were female. “Although there was only a small number of men affected with the disease, the men do seem to have a significantly earlier age of onset than women,” which has been previously reported, said Dr. Kerkemeyer. The researchers also noted that there was generally a delay in presenting to the clinic, with a mean interval of 4.9 years between disease onset and presentation.

The most common treatment was topical steroids, used to treat 31 patients, followed by tetracyclines – minocycline or doxycycline – used to treat 21 patients, and hydroxychloroquine, used to treat 18 patients. Some patients were also treated with steroid-sparing immunosuppressants, including methotrexate, mycophenolate, and cyclosporine. Fourteen patients were also treated with intralesional steroids, and seven were treated with topical tacrolimus.

The researchers used a graded four-point scale to assess patients’ response to treatment, which corresponded to remission, partial improvement, no change, and worsening of disease, based on patients’ clinical signs, symptoms, and extent of alopecia.

Only a small proportion – about 15% – of patients achieved remission, which was seen with topical steroids, hydroxychloroquine, and doxycycline. About one-third of patients treated with doxycycline actually showed a worsening of symptoms.

The greatest proportion (75%) of patients with partial remission was among those treated with systemic acitretin, although the numbers were low (three of four patients who received this therapy).

In addition, one of the seven patients treated with minocycline achieved partial remission during this therapy, one showed a worsening of the condition, and the remaining five were unchanged. Among those treated with an immunosuppressant, the 3 patients treated with mycophenolate had no change in the condition; 4 of the 10 patients treated with methotrexate achieved partial remission, 4 were unchanged, and 2 experienced a worsening of the condition. One of the three patients treated with cyclosporine achieved partial remission while the other two remained unchanged. With topical tacrolimus, two patients achieved partial remission, two showed a worsening of the condition, and the remaining three were unchanged.

The response rates to treatment significantly decreased with subsequent therapies: 18 of the 32 patients responded to first-line treatments, compared with 7 of 19 who received second-line treatment and only 1 of 9 patients who received third-line treatment. “Many patients were not responsive to therapy, highlighting the difficulty of treating this scarring alopecia,” Dr. Kerkemeyer said.

In an interview, she said that topical or intralesional steroids seemed to be the best first-line option because they are associated with fewer side effects than other options. “They were easier to start off in patients first,” and for those who do not respond, switching to another treatment, such as topical tacrolimus, if they wanted a topical option, or an oral treatment, such as an immunosuppressant like methotrexate, she noted.

No conflicts of interest were declared.

[email protected]

 

SYDNEY – Responses to treatments for lichen planopilaris varied widely, and decreased with second- and third-line therapies, in a retrospective study, Karolina Kerkemeyer, MD, said at the annual meeting of the Australasian College of Dermatologists.

An analysis of computerized medical records for 32 patients who had been treated for lichen planopilaris at a tertiary referral hair center in Australia was conducted from 2012 to 2016 by Dr. Kerkemeyer of the University of Notre Dame Australia, Werribee, and Jack Green, MD, of the Skin and Cancer Foundation and St. Vincent’s Hospital in Melbourne. The study excluded patients with a dual diagnosis, or those followed for less than 12 months.

The mean age of the patients was about 60 years; 29 were female. “Although there was only a small number of men affected with the disease, the men do seem to have a significantly earlier age of onset than women,” which has been previously reported, said Dr. Kerkemeyer. The researchers also noted that there was generally a delay in presenting to the clinic, with a mean interval of 4.9 years between disease onset and presentation.

The most common treatment was topical steroids, used to treat 31 patients, followed by tetracyclines – minocycline or doxycycline – used to treat 21 patients, and hydroxychloroquine, used to treat 18 patients. Some patients were also treated with steroid-sparing immunosuppressants, including methotrexate, mycophenolate, and cyclosporine. Fourteen patients were also treated with intralesional steroids, and seven were treated with topical tacrolimus.

The researchers used a graded four-point scale to assess patients’ response to treatment, which corresponded to remission, partial improvement, no change, and worsening of disease, based on patients’ clinical signs, symptoms, and extent of alopecia.

Only a small proportion – about 15% – of patients achieved remission, which was seen with topical steroids, hydroxychloroquine, and doxycycline. About one-third of patients treated with doxycycline actually showed a worsening of symptoms.

The greatest proportion (75%) of patients with partial remission was among those treated with systemic acitretin, although the numbers were low (three of four patients who received this therapy).

In addition, one of the seven patients treated with minocycline achieved partial remission during this therapy, one showed a worsening of the condition, and the remaining five were unchanged. Among those treated with an immunosuppressant, the 3 patients treated with mycophenolate had no change in the condition; 4 of the 10 patients treated with methotrexate achieved partial remission, 4 were unchanged, and 2 experienced a worsening of the condition. One of the three patients treated with cyclosporine achieved partial remission while the other two remained unchanged. With topical tacrolimus, two patients achieved partial remission, two showed a worsening of the condition, and the remaining three were unchanged.

The response rates to treatment significantly decreased with subsequent therapies: 18 of the 32 patients responded to first-line treatments, compared with 7 of 19 who received second-line treatment and only 1 of 9 patients who received third-line treatment. “Many patients were not responsive to therapy, highlighting the difficulty of treating this scarring alopecia,” Dr. Kerkemeyer said.

In an interview, she said that topical or intralesional steroids seemed to be the best first-line option because they are associated with fewer side effects than other options. “They were easier to start off in patients first,” and for those who do not respond, switching to another treatment, such as topical tacrolimus, if they wanted a topical option, or an oral treatment, such as an immunosuppressant like methotrexate, she noted.

No conflicts of interest were declared.

[email protected]