Clinical efficacy and safety of methotrexate versus hydroxychloroquine in preventing lichen planopilaris progress: A randomized clinical trial

Background: lichen planopilaris is an inflammatory cicatricial alopecia,and its management is a challenge for dermatologists. we aimed to compare the efficacy of methotrexate and hydroxychloroquine on refractory lichen planopilaris. methods: in a randomized clinical trial,29 patients were randomly allocated to receive either 15 mg methotrexate/week or 200 mg hydroxychloroquine twice a day for 6 months. side effects,symptoms/signs,and laboratory tests were assessed periodically. lichen planopilaris activity index (lppai) was measured before intervention and at 2,4,and 6 months after. the changes from baseline to the end of the study were analyzed within each group and between the two groups by per-protocol and intention-to-treat analysis. results: after 2 months,mean (standard deviation [sd]) decrease in lppai in methotrexate group was significantly more than that in hydroxychloroquine group (1.68 [1.24] vs. 0.8 [0.71],respectively,p = 0.047). furthermore,after 6 months,mean (sd) decrease in lppai in methotrexate group was significantly higher than that in hydroxychloroquine group (3.3 [2.09] vs. 1.51 [0.91],respectively,p = 0.01). the following symptoms/signs showed significant improvements in frequency and/or severity in methotrexate group after intervention: pruritus (p = 0.007),erythema (p = 0.01),perifollicular erythema (p = 0.01),perifollicular scaling (p = 0.08),spreading (p = 0.001),and follicular keratosis (p = 0.04). in hydroxychloroquine group,only erythema (p = 0.004) showed significant improvement. conclusions: methotrexate was more effective than hydroxychloroquine in treating refractory lichen planopilaris. © 2017 international journal of preventive medicine.