Apremilast for Lichen Planopilaris and Frontal Fibrosing Alopecia: A Case Series
Main Article Content
lichen planopilaris, frontal fibrosing alopecia, alopecia, apremilast, treatment
Importance: Lichen planopilaris and frontal fibrosing alopecia are characterized by scarring alopecia associated with pruritus, inflammation, and pain of affected areas. There is a paucity of data on treatment options for these disorders. The available management options are associated with significant adverse effects and poor efficacy.
Objective: To explore apremilast as a treatment option for refractory lichen planopilaris and frontal fibrosing alopecia
Design: This is a retrospective case series analyzing the outcomes of four patients with refractory lichen planopilaris or frontal fibrosing alopecia treated with apremilast.
Setting: The patients were seen in the faculty practice of an academic institution in New York City.
Participants: Four female patients with biopsy confirmed lichen planopilaris or frontal fibrosing alopecia refractory to currently used treatments
Observations: We report a case series of four patients with lichen planopilaris and frontal fibrosing alopecia who had failed multiple previous treatments, including intralesional steroids, anti-malarials, oral anti-inflammatory agents, minocycline, acitretin, mycophenolate mofetil, and laser treatment who responded to apremilast. While two of these patients discontinued the drug due to adverse effects such as gastrointestinal discomfort, clinical improvement was seen in every patient.
Conclusions: To date, this is the first report of the use of apremilast for lichen planopilaris or frontal fibrosing alopecia, indicating its possible use in patients refractory to other treatments.
Holmes S. Frontal Fibrosing Alopecia. Skin Therapy Lett. 2016;21(4):5-7.
Vano-Galvan S, Molina-Ruiz AM, Serrano- Falcon C, et al. Frontal fibrosing alopecia: a multicenter review of 355 patients. J Am Acad Dermatol. 2014;70(4):670-678.
Alexis AF BV. Skin of Color: A Practical Guide to Dermatologic Diagnosis and Treatment. 1 ed: Springer-Verlag New York; 2013.
Karnik P, Tekeste Z, McCormick TS, et al. Hair follicle stem cell-specific PPARgamma deletion causes scarring alopecia. J Invest Dermatol. 2009;129(5):1243-1257.
Mesinkovska NA, Tellez A, Dawes D, Piliang M, Bergfeld W. The use of oral pioglitazone in the treatment of lichen planopilaris. J Am Acad Dermatol. 2015;72(2):355-356.
Thaci D, Kimball A, Foley P, et al. Apremilast, an oral phosphodiesterase 4 inhibitor, improves patient-reported outcomes in the treatment of moderate to severe psoriasis: Results of two phase III randomized, controlled trials. J Eur Acad Dermatol Venereol. 2016.
Paul J, Foss CE, Hirano SA, Cunningham TD, Pariser DM. An open-label pilot study of apremilast for the treatment of moderate to severe lichen planus: a case series. J Am Acad Dermatol. 2013;68(2):255-261.
Lyakhovitsky A, Amichai B, Sizopoulou C, Barzilai A. A case series of 46 patients with lichen planopilaris: Demographics, clinical evaluation, and treatment experience. J Dermatolog Treat. 2015 Jun;26(3):275-9.