Treatment Options and Emerging Therapies for Lichen Planopilaris

Conclusions

• Lichen planopilaris is a chronic lymphocytic scarring alopecia that permanently destroys follicles, so the main treatment goal is to slow progression and preserve remaining hair rather than restore lost hair.
• There is no single standard therapy for lichen planopilaris, and treatment must be individualized because responses vary widely and relapses are common.
• Topical and intralesional corticosteroids remain useful first-line options, but their benefits are modest and are often enhanced when combined with other agents.
• Hydroxychloroquine appears to be a common first-line systemic therapy with moderate response rates and generally good tolerability.
• Doxycycline can help some patients with milder disease, but its overall efficacy is limited and variable.
• Short courses of oral prednisone can rapidly control severe or rapidly progressive disease, but the high relapse rate and steroid toxicity limit long-term use.
• Second-line systemic agents such as methotrexate, cyclosporine, pioglitazone, and mycophenolate mofetil can be effective in refractory cases, but they require careful monitoring for adverse effects.
• Platelet-rich plasma, finasteride/dutasteride, thalidomide, low-dose naltrexone, hair transplantation, and laser-based approaches have inconsistent or limited evidence and should be considered experimental or selective options.
• JAK inhibitors are an emerging and promising class for persistent or refractory disease, but the current evidence is still limited and they should be used with appropriate safety screening and monitoring.
• Newer therapies such as topical cyclosporine and adipose tissue-derived exosomes are intriguing but remain supported only by very limited early evidence.
• Clinical appearance alone may not reflect disease activity, since histologic inflammation can persist in normal-appearing scalp, so both subjective symptoms and objective measures should be used to assess progression.
• Early diagnosis, avoiding scalp trauma and triggers, and starting treatment promptly are emphasized as the best way to preserve hair and quality of life.