Tofacitinib for the treatment of lichen planopilaris: A case series

Christine C Yang, Trisha Khanna, Brigitte Sallee, Angela M Christiano, Lindsey A Bordone, Christine C Yang, Trisha Khanna, Brigitte Sallee, Angela M Christiano, Lindsey A Bordone

Abstract

Lichen planopilaris (LPP) is an inflammatory cicatricial alopecia for which many different therapies are attempted with varying success. The Janus kinase (JAK) inhibitor, tofacitinib, has been shown to be effective in treating the noncicatricial alopecia, alopecia areata. As in alopecia areata, upregulation of interferon and JAK signaling may play a role in LPP. We retrospectively reviewed the cases of 10 patients with recalcitrant LPP who were treated with oral tofacitinib. Patients received oral tofacitinib 5 mg twice or three times daily for 2-19 months as either monotherapy or adjunctive therapy to other ongoing treatments including intralesional triamcinolone, hydroxychloroquine, and tacrolimus ointment. Eight patients had clinical improvement in LPP with tofacitinib as either monotherapy (4/10) or adjunctive therapy (4/10). LPP Activity Index (LPPAI) before and after treatment was measured in seven patients and was significantly different (6.22 before treatment, 3.08 after treatment; p value = .0014). Reduction in LPPAI ranged from 30 to 94%. One patient complained of 10 pound (4.5 kg) weight gain after 12 months on tofacitinib. No other adverse effects were reported. Treatment with oral tofacitinib either as monotherapy or adjunctive therapy can lead to measurable improvement in recalcitrant LPP.

Keywords: JAK inhibitors; alopecia; frontal fibrosing alopecia; lichen planopilaris; scarring alopecia; tofacitinib.

Conflict of interest statement

Columbia University has filed patents on Dr. Christiano's research on the use of JAK inhibitors in the treatment of hair loss disorders, which have been licensed to Aclaris Therapeutics, Inc. Dr. Yang, Dr. Sallee, Dr. Bordone, and Ms. Khanna have no conflicts of interest.

© 2018 The Authors. Dermatologic Therapy published by Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
A case of frontal fibrosing alopecia before (a) and after (b) 9 months of tofacitinib 5 mg twice daily also treated with monthly intralesional triamcinolone, after having failed intralesional triamcinolone, topical steroids, doxycycline, and hydroxychloroquine. A case of severe lichen planopilaris before (c) and after (d) 10 months of tofacitinib 5 mg twice daily monotherapy after having failed intralesional triamcinolone, doxycycline, and finasteride

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