Sequential Small-Molecule Therapy for Lymphocytic Cicatricial Alopecia: A Multicenter Prospective Cohort Pilot Study

March 2026 in “ Journal of the American Academy of Dermatology ”

Y J Li, Guanghui Shao, Qiuwei Tao, Yuqian Li, Yizhou Wang, Qilin Zhu, Jing Zhu, Sangsang Qiu, Zhongming Li, Yanyun Wang, Xufeng Du

lymphocytic cicatricial alopecia small-molecule therapy Tofacitinib Crisaborole Apremilast Lichen Planopilaris Activity Index LCA Lichen Planopilaris

Studysummary In this study, patients with active lymphocytic cicatricial alopecia showed significant improvement using a three-stage treatment regimen involving Tofacitinib, Apremilast, and Crisaborole, with 93.5% experiencing marked improvement and only three mild adverse events reported.

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This multicenter prospective cohort pilot study evaluated a three-stage sequential small-molecule therapy for active lymphocytic cicatricial alopecia (LCA) in 33 patients, with 31 completing the regimen. The treatment involved oral Tofacitinib and topical Crisaborole (Stage I), oral Apremilast and topical Crisaborole (Stage II), and topical Crisaborole alone (Stage III). Results showed a significant decrease in the Lichen Planopilaris Activity Index (LPPAI) from 5.65 ± 1.45 to 0.75 ± 0.27, with an 85.5% improvement rate (P < .001) by Stage III. Notably, 93.5% of patients experienced marked improvement, and only 3 mild adverse events were reported. Despite limitations such as a small sample size, lack of a control group, and short follow-up, the regimen was well tolerated and presents a promising treatment option for active LCA.

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Research cited in this study

8 / 8 results

research Efficacy and Safety of Tofacitinib in the Treatment of Adults with Lichen Planopilaris: A Randomized Placebo-Controlled Trial

3 citations , July 2025 in “International Immunopharmacology”

research Treatment Modalities for Lymphocytic and Neutrophilic Scarring Alopecia

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This article discusses various treatments for primary cicatricial alopecia with a focus on early intervention to manage symptoms and improve hair density, but it reports no new clinical results.

research Drugs Targeting Epithelial–Mesenchymal Transition Molecules for Treatment of Lichen Planopilaris

3 citations , May 2022 in “Clinical and experimental dermatology”

This review discusses potential EMT-targeting drugs for treating lichen planopilaris and emphasizes the need for clinical trials, as current evidence is limited to individual cases or case series.

research Lichen Planopilaris and Frontal Fibrosing Alopecia: Review and Update of Diagnostic and Therapeutic Features

13 citations , April 2022 in “Anais brasileiros de dermatologia/Anais Brasileiros de Dermatologia”

This comprehensive literature review highlighted that lichen planopilaris and frontal fibrosing alopecia, both primary scarring alopecias, are diagnosed via scalp biopsy, with no standardized treatments available, necessitating individualized therapeutic approaches based on patient characteristics.

Hair Loss in Lichen Planopilaris and Frontal Fibrosing Alopecia: Not Always Irreversible

research Fibrosing Alopecia in a Pattern Distribution

158 citations , February 2000 in “Archives of dermatology”

This study reports that some patients with androgenetic alopecia may also exhibit clinical and histological features of inflammation and fibrosis, similar to those found in lichen planopilaris.