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Sequential small-molecule therapy for lymphocytic cicatricial alopecia: A multicenter prospective cohort pilot study
Yanhua Li1, Guanghui Shao2, Qiuwei Tao3
1Department of Dermatology, The First School of Clinical Medicine, Faculty of Medicine, Yangzhou University, Yangzhou, China.
Background:
Lymphocytic cicatricial alopecia (LCA) is a rare disorder causing irreversible hair follicle stem cell damage, with limited evidence supporting systemic treatments.
Objective:
To assess the efficacy and safety of a predefined three-stage sequential small-molecule therapy for active LCA.
Methods:
This multicenter prospective cohort pilot study enrolled adults with histopathologically confirmed active LCA at 3 Chinese tertiary centers. The regimen included oral Tofacitinib + topical Crisaborole (Stage I), oral Apremilast + topical Crisaborole (Stage II), and topical Crisaborole alone (Stage III). Primary outcomes were longitudinal Lichen Planopilaris Activity Index (LPPAI) and its improvement rate (ILPPAIS%).
Results:
Of 33 patients, 31 completed the regimen. Baseline LPPAI (5.65 ± 1.45) decreased significantly to 0.75 ± 0.27 (ILPPAIS% 85.5%, P < .001) at Stage III; 93.5% achieved marked improvement with only 3 mild adverse events.
Limitations:
Small sample size, lack of control group, and short follow-up.
Conclusion:
In this patient cohort, three-stage sequential regimen was well tolerated and offers a promising treatment option for active LCA.
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