Prag Batra1, Kumar Sukhdeo1,2, Jerry Shapiro1. 1. Department of Dermatology, New York University School of Medicine, New York, New York, USA. 2. Pilaris Dermatology, New York, New York, USA.
Abstract
INTRODUCTION: We present 2 cases in which typically irreversible lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) showed signs of reversal. CASE PRESENTATION: A 27-year-old Caucasian man presented with hair loss and intense pruritus on the vertex scalp for 4 years with biopsy-proven LPP and having failed multiple pharmacologic modalities. Six months after adding oral tofacitinib and later dapsone, he demonstrated reduced scalp visibility, evidence of crown and vertex hair regrowth, and elimination of itch. A 45-year-old premenopausal Hispanic woman presented with eyebrow loss for 3.75 years and hair loss for 9 months with biopsy-proven FFA. After beginning oral finasteride and hydroxychloroquine, triamcinolone injections, and topical minoxidil, she initially worsened over 11 months but subsequently improved over 6 months, demonstrating hair and eyebrow regrowth, reduction in glabella-hairline distance, and new absence of frontal hair line hyperkeratosis and inflammation. DISCUSSION/ CONCLUSION: Cicatricial alopecia involves inflammation with JAK-STAT upregulation. We report a positive clinical response in LPP to tofacitinib, a JAK1/3 inhibitor, and dapsone, an anti-neutrophilic agent. FFA is believed to involve autoimmune and/or hormonal processes. Here we report a positive clinical response to androgenic and immune modulators.
INTRODUCTION: We present 2 cases in which typically irreversible lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) showed signs of reversal. CASE PRESENTATION: A 27-year-old Caucasian man presented with hair loss and intense pruritus on the vertex scalp for 4 years with biopsy-proven LPP and having failed multiple pharmacologic modalities. Six months after adding oral tofacitinib and later dapsone, he demonstrated reduced scalp visibility, evidence of crown and vertex hair regrowth, and elimination of itch. A 45-year-old premenopausal Hispanic woman presented with eyebrow loss for 3.75 years and hair loss for 9 months with biopsy-proven FFA. After beginning oral finasteride and hydroxychloroquine, triamcinolone injections, and topical minoxidil, she initially worsened over 11 months but subsequently improved over 6 months, demonstrating hair and eyebrow regrowth, reduction in glabella-hairline distance, and new absence of frontal hair line hyperkeratosis and inflammation. DISCUSSION/ CONCLUSION: Cicatricial alopecia involves inflammation with JAK-STAT upregulation. We report a positive clinical response in LPP to tofacitinib, a JAK1/3 inhibitor, and dapsone, an anti-neutrophilic agent. FFA is believed to involve autoimmune and/or hormonal processes. Here we report a positive clinical response to androgenic and immune modulators.
Authors: Sergio Vañó-Galván; Ana M Molina-Ruiz; Cristina Serrano-Falcón; Salvador Arias-Santiago; Ana R Rodrigues-Barata; Gloria Garnacho-Saucedo; Antonio Martorell-Calatayud; Pablo Fernández-Crehuet; Ramón Grimalt; Beatriz Aranegui; Emiliano Grillo; Blanca Diaz-Ley; Rafael Salido; Sivia Pérez-Gala; Salvio Serrano; Jose Carlos Moreno; Pedro Jaén; Francisco M Camacho Journal: J Am Acad Dermatol Date: 2014-02-05 Impact factor: 11.527
Authors: Lauren C Strazzulla; Lorena Avila; Xiaoxue Li; Kristen Lo Sicco; Jerry Shapiro Journal: J Am Acad Dermatol Date: 2018-01 Impact factor: 11.527
Authors: Milène Kennedy Crispin; Justin M Ko; Brittany G Craiglow; Shufeng Li; Gautam Shankar; Jennifer R Urban; James C Chen; Jane E Cerise; Ali Jabbari; Mårten Cg Winge; M Peter Marinkovich; Angela M Christiano; Anthony E Oro; Brett A King Journal: JCI Insight Date: 2016-09-22