Add on 1mg/day minoxidil to standard treatment safe in lichen planopilaris patients: Study

A new study published in the journal of Dermatologic Therapy found that the addition of 1 mg/day minoxidil to the conventional therapy of lichen planopilaris (LPP) had no discernible impact on hair density/thickness or the Lichen Planopilaris Activity Index (LPPAI).

At least 25% of all cases of scarring alopecia are caused by lichen planopilaris. There is ongoing discussion on the precise pathogenesis of the disease. But, it is thought that the activation of lymphocytes against the bulge area, which contains germinal cells, is caused by the disruption of keratinocyte antigen expression, whether internal or external.

Scarring alopecia and irreparable hair loss are the results of this massive damage. Stopping inflammation is the main treatment objective for scarring alopecia, including LPP. At the moment, topical corticosteroids are frequently used in conjunction with hydroxychloroquine (HCQ) as the first line of therapy. Azathioprine, mycophenolate mofetil, cyclosporine, and methotrexate (MTX) are frequently saved for situations in which the first course of therapy is ineffective.

Enhancing hair thickness is another treatment objective in order to better hide the hair loss spots. In this sense, survival hair regrowth can be maximized with topical and low-dose oral minoxidil (OM), particularly in individuals who also have hereditary pattern alopecia. Thus, this research was set to assess the safety and efficacy of supplementing the conventional anti-inflammatory therapy for LPP with low-dose oral minoxidil.

For 6 months, 37 patients with LPP were randomized to receive either 1 mg/day minoxidil in addition to MTX plus clobetasol or 15 mg/week methotrexate (MTX) plus topical clobetasol. The effectiveness of the therapy was assessed using dermoscopy, conventional photography, and the Lichen Planopilaris Activity Index.

The study found LPPAI to be significantly improved in both groups (p < 0.001). The anagen pull test, scalp erythema, follicular prominency, milky red region, perifollicular erythema, pruritus, and pigmentation were among the signs and symptoms that showed significant improvements in frequency and/or severity in both groups.

However, only the MTX + low-dose OM group had improvements in discomfort, hair tufting, burning sensation, and spreading. Neither group's elongated blood vessels improved. The 2 groups did not significantly vary in terms of hair density or thickness. Overall, the effects of adding low-dose OM to the anti-inflammatory therapy regimen for LPP are investigated in this RCT. 

Source:

Saber, M., Dehghani, S., Fatemi Naeini, F., & Mohaghegh, F. (2025). Low‐dose oral minoxidil in lichen planopilaris: Efficacy and safety. Dermatologic Therapy, 2025(1). https://doi.org/10.1155/dth/1323718