Batra Prag, Sukhdeo Kumar, Shapiro Jerry
Department of Dermatology, New York University School of Medicine, New York, New York, USA.
Pilaris Dermatology, New York, New York, USA.
Skin Appendage Disord. 2020 Mar;6(2):125-129. doi: 10.1159/000505439. Epub 2020 Jan 31.
We present 2 cases in which typically irreversible lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) showed signs of reversal.
A 27-year-old Caucasian man presented with hair loss and intense pruritus on the vertex scalp for 4 years with biopsy-proven LPP and having failed multiple pharmacologic modalities. Six months after adding oral tofacitinib and later dapsone, he demonstrated reduced scalp visibility, evidence of crown and vertex hair regrowth, and elimination of itch. A 45-year-old premenopausal Hispanic woman presented with eyebrow loss for 3.75 years and hair loss for 9 months with biopsy-proven FFA. After beginning oral finasteride and hydroxychloroquine, triamcinolone injections, and topical minoxidil, she initially worsened over 11 months but subsequently improved over 6 months, demonstrating hair and eyebrow regrowth, reduction in glabella-hairline distance, and new absence of frontal hair line hyperkeratosis and inflammation.
DISCUSSION/CONCLUSION: Cicatricial alopecia involves inflammation with JAK-STAT upregulation. We report a positive clinical response in LPP to tofacitinib, a JAK1/3 inhibitor, and dapsone, an anti-neutrophilic agent. FFA is believed to involve autoimmune and/or hormonal processes. Here we report a positive clinical response to androgenic and immune modulators.
我们报告2例典型的不可逆性扁平苔藓样毛发角化病（LPP）和额部纤维性秃发（FFA）出现逆转迹象的病例。
一名27岁的白种男性，头顶头皮脱发伴剧烈瘙痒4年，活检证实为LPP，多种药物治疗均无效。在加用口服托法替布及随后的氨苯砜6个月后，他的头皮秃发情况改善，头顶和冠状区有毛发生长迹象，瘙痒消失。一名45岁的绝经前西班牙裔女性，眉毛脱落3.75年，脱发9个月，活检证实为FFA。在开始口服非那雄胺、羟氯喹、曲安奈德注射及外用米诺地尔后，她最初在11个月内病情加重，但随后在6个月内有所改善，表现为头发和眉毛再生，眉间至发际线距离减小，额部发际线处角化过度和炎症消失。
讨论/结论：瘢痕性秃发涉及JAK-STAT上调的炎症反应。我们报告LPP对JAK1/3抑制剂托法替布和抗中性粒细胞药物氨苯砜有积极的临床反应。FFA被认为涉及自身免疫和/或激素过程。在此我们报告FFA对雄激素调节剂和免疫调节剂有积极的临床反应。
