Commentary: Treatment of Lichen Planopilaris

In the 2010 document, the authors discuss the difficulty in treating lichen planopilaris (LPP) due to the lack of strong evidence for current therapies. They mention that the literature is comprised mostly of case reports and series without any randomized controlled trials. Treatments such as topical corticosteroids, tetracycline antibiotics, and systemic immunomodulators have shown inconsistent results. For instance, topical steroids resulted in 66% complete clearing in 30 patients but had high relapse rates, while hydroxychloroquine improved symptoms in 41% of 22 patients in one study but was ineffective in another with 12 patients. Mycophenolate mofetil showed some clinical improvement and was well-tolerated. The authors reference two articles that used the Lichen Planopilaris Activity Index (LPPAI) to assess treatment efficacy, which showed promising results, but they note the need for validation of this subjective measure. They suggest digital photography as a means to improve objectivity in future research. Despite the lack of strong evidence, topical and intralesional corticosteroids are recommended as first-line treatments, with tetracyclines and hydroxychloroquine as second-line options. For refractory cases, more potent systemic drugs may be considered, despite their potential adverse effects. The document emphasizes the necessity for more rigorous studies to establish effective treatments for LPP.