Antimalarial Drug Plus Adalimumab Aids Hair Regrowth in Lichen Planopilaris

When adalimumab (Humira) was added to a patient’s regimen of hydroxychloroquine, an antimalarial drug, there was significant hair regrowth, according to a case report for a woman with lichen planopilaris (LPP).

LPP is a type of scarring hair loss that occurs when lichen plaus, a relatively common inflammatory skin disease, affects areas of skin where hair grows. It destroys the hair follicle and replaces it with scarring, resulting in permanent hair loss. LPP’s causes and pathology are unknown.

The 61-year-old woman had a 2-year history of painful nodules and abscesses located in her groin and a 4-month history of patchy hair loss on her scalp suggestive of LPP, for which she was prescribed hydroxychloroquine, 200 mg twice a day, 5 days a week, and clobetasol 0.05% scalp lotion twice a day for 3 months.

The nodules and abscesses in her groin were consistent with Hurley stage II HS, for which she was also prescribed clindamycin and rifampin.

However, at the 2-month follow up, her LPP was unimproved and her HS was resistant to clindamycin and rifampin. The patient was then started on adalimumab at 160 mg in week 1, with dose reductions thereafter.

At a follow-up 3 months later, substantial improvements in both HS and RA were observed, including reduction of HS nodules and abscesses on the groin, and the patient’s LPP patches had hair regrowth and reduction in redness. Six months later, further hair regrowth was noted.

Prior to the changes in treatment, the patient’s scalp presented scarring patches (alopecia) in her frontal hairline, a receding hairline, and follicular hyperkeratosis consistent with frontal fibrosing alopecia. All showed improvements with the addition of adalimumab.

The authors said that a possible “combined therapeutic effect of adalimumab and hydroxychloroquine” may be responsible for the improvement in LPP, including the hair regrowth.

Prior studies have reported that adalimumab yielded positive results in the management of cutaneous and oral lichen planus. Additionally, an older case report showed successful use of adalimumab to treat therapy resistant LPP and folliculitis decalvans, although no hair regrowth was reported.

Hair regrowth has not been reported for those treated exclusively with hydroxychloroquine or a combination of hydroxychloroquine and topical corticosteroids. In some cases, studies have reported more hair loss in patients on hydroxychloroquine, leading the authors in this case to conclude that hydroxychloroquine alone was unlikely to have caused the hair regrowth.

“This case report highlights the promise for further understanding of this condition and its treatments,” the authors wrote.

“Current therapeutic options for LPP often fail to alleviate active inflammation and prevent disease progression,” making LPP difficult to treat, the authors wrote, concluding that this case opens the door for further investigation of the combined effects of adalimumab and hydroxychloroquine for the treatment of LPP.

Reference

Alam MS, LaBelle B. Treatment of lichen planopilaris with adalimumab in a patient with hidradenitis suppurativa and rheumatoid arthritis. JAAD Case Reports. 2020;6(3):219-221. doi:10.1016/j.jdcr.2019.12.016.