Sequential small-molecule therapy for lymphocytic cicatricial alopecia: A multicenter prospective cohort pilot study - 28/03/26

Doi : 10.1016/j.jaad.2026.03.011

Yanhua Li, MD, PHD ^a, Guanghui Shao, MM ^b, Qiuwei Tao, MM ^c, Yuqian Li, MM ^b, Yizhou Wang, BM ^a, Qilin Zhu, MM ^b, Jing Zhu, MM ^b, Sangsang Qiu, PHD ^d,^e, Zhongming Li, MM ^b, Yanyun Wang, MM ^f,^⁎ , Xufeng Du, MD ^b,^⁎

^a Department of Dermatology, The First School of Clinical Medicine, Faculty of Medicine, Yangzhou University, Yangzhou, China

^b Department of Dermatology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi Medical Center, Nanjing Medical University, Wuxi, China

^c Department of Surgery, Shanghai Qingdong Farm Hospital, Shanghai, China

^d Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China

^e Department of Infection Control, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China

^f Department of Dermatology, Affiliated Zhengzhou Central Hospital of Zhengzhou University, Zhengzhou, China

^∗ Correspondence to: Yanyun Wang, MM, Department of Dermatology, Affiliated Zhengzhou Central Hospital of Zhengzhou University, North 16 Tongbai Rd, Zhengzhou, 450007, China. Department of Dermatology Affiliated Zhengzhou Central Hospital of Zhengzhou University North 16 Tongbai Rd Zhengzhou 450007 China ^∗∗ Correspondence to: Xufeng Du, MD, Department of Dermatology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi Medical Center, Nanjing Medical University, 299 Qingyang Rd, Wuxi, 214023, China. Department of Dermatology The Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi Medical Center Nanjing Medical University 299 Qingyang Rd Wuxi 214023 China

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 28 March 2026

Abstract

Background

Lymphocytic cicatricial alopecia (LCA) is a rare disorder causing irreversible hair follicle stem cell damage, with limited evidence supporting systemic treatments.

Objective

To assess the efficacy and safety of a predefined three-stage sequential small-molecule therapy for active LCA.

Methods

This multicenter prospective cohort pilot study enrolled adults with histopathologically confirmed active LCA at 3 Chinese tertiary centers. The regimen included oral Tofacitinib + topical Crisaborole (Stage I), oral Apremilast + topical Crisaborole (Stage II), and topical Crisaborole alone (Stage III). Primary outcomes were longitudinal Lichen Planopilaris Activity Index (LPPAI) and its improvement rate (ILPPAIS%).

Results

Of 33 patients, 31 completed the regimen. Baseline LPPAI (5.65 ± 1.45) decreased significantly to 0.75 ± 0.27 (ILPPAIS% 85.5%, P < .001) at Stage III; 93.5% achieved marked improvement with only 3 mild adverse events.

Limitations

Small sample size, lack of control group, and short follow-up.

Conclusion

In this patient cohort, three-stage sequential regimen was well tolerated and offers a promising treatment option for active LCA.

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Key words : Apremilast, Crisaborole, Lymphocytic cicatricial alopecia, sequential therapy, small-molecule agents, Tofacitinib

Abbreviations used : DLE, EMT, FAPD, FFA, HFSCs, ILPPAIS%, LCA, LPP, LPPAI, M, MA, MTX, PDE, PRP, TM

Plan

Introduction

Methods

Study design and setting

Participants

Sequential therapy protocol

Concomitant therapies

Outcome measures

Statistical analysis

Results

Patient characteristics and treatment exposure

Changes in LPPAI and clinical response

Dermoscopic and clinical findings

Safety and tolerability

Sensitivity analysis

Discussion

Limitations

	Dr Li and Author Shao are cofirst authors.
	Funding sources: This study was supported by Scientific Research Project of Wuxi Health Commission ( Z202319 ), Key Project of Wuxi Medical Center, Nanjing Medical University ( WMCJ202401 ).
	Patient consent: Consent for the publication of recognizable patient photographs or other identifiable material was obtained by the authors and included at the time of article submission to the journal stating that all patients gave consent with the understanding that this information may be publicly available.
	IRB approval status: Reviewed and approved by the Ethics Committee of the Affiliated Wuxi People's Hospital of Nanjing Medical University; approval #KY23077.