Lichen planopilaris (LPP) is a chronic inflammatory scalp condition that damages hair follicles, leading to
scarring and hair loss. This inflammation can lead to permanent hair loss, as well as symptoms like scalp
redness, itching, and pain. Many patients do not improve with currently available treatments, including
intralesional corticosteroids, hydroxychloroquine, and Janus kinase inhibitors, highlighting the need for
additional treatment options.
What is deucravacitinib, and how does it work?
Deucravacitinib is an oral medication that blocks tyrosine kinase 2 (TYK2), a protein in the immune system that
helps drive inflammation. By selectively blocking TYK2, this medication reduces overactive immune responses
without suppressing the entire immune system. It has been shown to be effective in treating lichen planus, a
chronic inflammatory skin condition that causes itchy and painful rashes. Because LPP is a form of lichen
planus that specifically affects hair follicles, targeting TYK2 may also help reduce scalp inflammation.
Study Overview
This retrospective study reviewed 4 patients (3 females and 1 male) with LPP who continued to have active
disease despite previous treatments, including hydroxychloroquine, baricitinib, glycyrrhizin, doxycycline,
spironolactone, intralesional corticosteroids, and topical minoxidil. The median age at diagnosis was 37 years,
and the patients had been living with LPP for a median of 6.5 years. During the study period, the patients
continued other treatments such as spironolactone, hydroxychloroquine, gabapentin, and topical minoxidil. All
patients were treated with deucravacitinib at a dose of 6 mg per day for at least 12 weeks. Disease activity was
assessed using the Lichen Planopilaris Activity Index (LPPAI), which measures symptoms such as itching,
pain, burning, scalp redness, and scaling.
Key Findings
All four patients showed improvement after at least 12 weeks of treatment with deucravacitinib. LPPAI scores
decreased from a median of 3.29 before treatment to 0.84 after treatment, an almost 80% reduction in disease
activity. All patients reported that their itching and pain resolved, and that their scalp redness and scaling
improved. One patient also reported partial hair regrowth. Regarding side effects, one patient developed mild
hand eczema and a herpes simplex infection, both of which resolved after stopping the medication.
Implications and limitations
The findings of this study suggest that deucravacitinib, when used in combination with other treatments, can
improve symptoms such as scalp inflammation, itching, and pain in patients with LPP who have not responded
to other treatments. The patients in this study experienced improvements in their LPP with limited side effects.
However, this study was limited by its very small sample size and short follow-up period. Larger clinical trials
with longer follow-up periods are needed to better understand the long-term effectiveness and safety of
deucravacitinib for the treatment of LPP.
References
Ju D, Zhou L, Liu X, et al. Treatment of lichen planopilaris with the TYK-2 inhibitor deucravacitinib. J Am
Acad Dermatol. 2026;94(2):678-680. doi:10.1016/j.jaad.2025.10.047
Summarized by: Nancy Anabaraonye, BA – Harvard Medical School
Reviewed by: Dr. Kathie Huang, MD, FAAD
