Lichen planopilaris (LPP) is a scarring type of hair loss where the immune system attacks hair follicles, causing permanent hair loss. One form, frontal fibrosing alopecia (FFA), leads to a slow receding hairline, often starting at the front and sides of the scalp, and may also affect eyebrows and eyelashes. Recent research suggests that a specific pathway in the immune system, called the JAK-STAT pathway, is involved in this destructive process. Because of this, drugs known as JAK inhibitors, like tofacitinib, show promise as treatments for LPP and FFA. JAK inhibitors have several available formulations, including oral (taken by mouth) and topical (applied to the skin). Oral JAK inhibitors can cause systemic side effects, including immunosuppression and an increased risk of blood clots, etc. Topical JAK inhibitors may offer benefits with fewer side effects, but they have not been well-studied for scarring hair loss.
This study looked at using a topical form of tofacitinib to treat patients with LPP or FFA. The researchers reviewed the cases of 41 patients treated with tofacitinib cream for at least three months. Tofacitinib was used as a standalone therapy in 24.4% of patients and as an add-on to other standard treatments, such as Rogaine and topical or injectable steroids, in the remaining three-quarters of patients. 92% of patients with FFA or a combination of FFA/LPP, had improvement of or stabilization of the frontal hairline, but 8% had increased hairline recession. They found that, on average, patients showed a 48% improvement in disease activity after six months.
A small number of patients experienced mild side effects such as scalp irritation and acne, which largely went away after a decrease in application frequency. Overall, the treatment was well tolerated
These findings suggest that topical tofacitinib could be a safe and effective alternative for patients with LPP or FFA, especially since there are currently no FDA-approved treatments for these conditions. However, more controlled studies with larger groups of patients are needed to confirm these results.
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Article Summary By Andrea Quartey, MD Candidate at Lewis Katz School of Medicine at Temple University, 2024 | Reviewed by Melissa Piliang, MD
References:
Chen LC, Ogbutor C, Kelley KJ, Senna MM. Topical tofacitinib for patients with lichen planopilaris and/or frontal fibrosing alopecia. J Am Acad Dermatol. 2024 Jun;90(6):1260-1262. doi: 10.1016/j.jaad.2024.01.060. Epub 2024 Feb 2. PMID: 38311243.
