Efficacy of Methotrexate remains same in Lichen Planopilaris independent of addition of corticosteroids

Iran: A recent study has concluded that the efficacy and safety of Methotrexate with and without corticosteroids remain the same. The study clarified that the addition of oral corticosteroids is not required.

The research article is published in Dermatology Research and Practice.

It is already known that Lichen planopilaris (LPP) is a rare inflammatory disorder of the scalp leading to cicatricial alopecia.

This disease has a rare prevalence, and none of the treatment approaches has been approved.

In treating this disease, Methotrexate and corticosteroid are used as second or third-line therapy. The previous studies have discussed the effectiveness of combined Methotrexate and corticosteroid for treating dermatological and immunological diseases. Here comes the question of efficacy. There is an unclarity on how efficacious this combination is for managing LPP.

Adding more research and clarity consideration on this rare disease treatment, a study was conducted by a team of researchers led by Dr Farahnaz Fatemi from the Department of Dermatology, School of Medicine Skin Disease and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran to establish a comparison between Methotrexate alone and in combination with corticosteroid in managing LPP.

The conclusive points of the study are:

• This trial was performed on 28 patients (February 2015-December 2016)

• 24 patients completed the trial.

• Fourteen patients were given 15 mg of Methotrexate per week.

• The remaining 14 patients were given a combination of 200 mg prednisolone and 15 mg methotrexate per week.

• The lichen planopilaris activity index (LPPAI) score was the primary outcome measured in the study.

• The researchers also evaluated the photographic changes and symptoms study.

• In the follow-up period, there was a decrease in the mean of LPPAI in both groups with a similar pattern.

• Between the two intervention groups, there was no record of a statistically significant difference in consideration of the LPPAI score.

• No difference was recorded in both groups' symptoms and photographic assessments during follow-up.

• One adverse effect was exclusively reported in both groups.

The researchers concluded, "Our study results have depicted that methotrexate therapy with and without corticosteroids display similarities in efficacy and safety."

The study's limitations include small sample size, the lack of information, etc.

They said our study had limitations, but this is the first trial assessing the efficacy of the combination of oral prednisolone with Methotrexate. We reported no superiority in the study and warrant further research to add validation to our study results.

Further reading:

Farahnaz Fatemi, Farifteh Esfahanian, Ali Asilian, Fatemeh Mohaghegh, Mina Saber, "Comparative Efficacy Study Combination of Oral Methotrexate and Prednisolone versus Oral Methotrexate in Patients with Lichen Planopilaris", Dermatology Research and Practice, vol. 2022, Article ID 3792489, 8 pages, 2022