Season 7, Episode 10, Topical JAK Inhibitors for LPP/FFA

Welcome to another episode of the Evidence-Based Hair Podcast. In this episode, Dr. Donovan will explore a study on the use of topical tofacitinib for treating lichen planopilaris and frontal fibrosing alopecia.
We'll delve into a groundbreaking study by Dr. Maryanne Senna and colleagues from Boston, examining the effectiveness and side effects of topical 2% tofacitinib for FFA and LPP. The study's results provide encouraging data, showing that about 31.6% of patients experienced improvement, and 60.5% saw disease stabilization.
Join us as we explore the potential of topical JAK inhibitors in managing scarring alopecia, their practical applications, and the implications for future treatment protocols. Don't miss our insightful discussion on this emerging therapy and how it could transform patient care.
Next month, we'll shift gears to discuss spironolactone and its role in treating androgenetic hair loss in women. Stay tuned!
STUDIES REFERENCED:
Li-Chi Chen, Chino Ogbutor, Kristen J Kelley, Maryanne M Senna. Topical tofacitinib for patients with lichen planopilaris and/or frontal fibrosing alopecia. J Am Acad Dermatol. 2024 Jun;90(6):1260-1262. doi: 10.1016/j.jaad.2024.01.060. Epub 2024 Feb 2.
Yang C.C., Khanna T., Sallee B., Christiano A.M., Bordone L.A.: Tofacitinib for the treatment of lichen planopilaris: a case series. Dermatol Ther 2018; 31:
Moussa A., Bhoyrul B., Asfour L., Kazmi A., Eisman S., Sinclair R.D.: Treatment of lichen planopilaris with baricitinib: a retrospective study. J Am Acad Dermatol 2022; 87: pp. 663-666.
Plante J., Eason C., Snyder A., Elston D.: Tofacitinib in the treatment of lichen planopilaris: a retrospective review. J Am Acad Dermatol 2020; 83: pp. 1487-1489.

[@cindykraft4490]

I have LPP and am using a topical 2% Tofacitinib for the past 18 months. For me, it works better than Clobetesol at addressing itching and I have lots of new re-growth. (I've now weaned off Clobetesol use on my scalp). I still have a mostly full head of hair (my LPP has remained relatively mild, though I've had flares here and there). I didn't even know that I'd had so much shedding in some areas until I started seeing all the re-growth after starting the topical Tofa. I get mine from Skin Medicinals in the U.S. and it's $75 for a bottle that lasts me about 7-10 weeks. I also use topical Minoxidil and LDN but have been using both for years (no change to those protocols since starting the topical Tofa). I used Plaquenil in the past (several years ago) and had great success but had to stop due to side effects. Very pleased with the topical Tofa.

[@frebra111]

Hello! thank you for telling us about your experience. Could you share with us what adverse effect you had with Hydroxychloroquine?

[@churrochavez7020]

Around how long does it take for hair regrowth? Will I be able to stop using it once my hair grows back or will it fall?

[@pamedwards6522]

I think I may also have LPP/FAA but in the meanwhile, I know I have sebhorraic dermatitis and AGA. I have read on your website as well that fish oils (Omega 3's) is a good supplement to take to help with hair loss/growth. I have a krill oil supplement I was planning to take since I read that it binds more to phospholipids while fish oil binds to triglycerides. Based on how seb derm works, which do you think is better?

[@churrochavez7020]

Is topical tofacitinib more effective than taking tofacitinib orally?

[@donovanmedical9780]

@@churrochavez7020 No, it is not. But is is much much safer!

[@MA-me9hc]

Hi Doc. Have you had any luck with insurance companies covering JAK Inhibitors for Scarring Alopecia?

[@donovanmedical9780]

@@MA-me9hc yes! It can be alot of letters back and forth!! Yes, yes, yes!

[@churrochavez7020]

Will medical cover tofacitinib cream?

[@donovanmedical9780]

it depends on which of the 195 countries one lives in an which insurance policy a patient has and what the indication is for.

[@churrochavez7020]

​@@donovanmedical9780I live in California and I want to use it on some bald spots I have due to lichen Planopilaris

[@SouhairNakad]

Very informative!!! Thank you. I which you were here in US.

[@guillermorivera6332]

Doc , Hace you ever tried Calcipotriol on Scarring alopecias ? I am havingamazing results in FD with Claritromycin plus bactrim plus topical Calcipotriol for the last 12 monts . On Humira before with same results on 40 mg weekly , but to many side effects . Can’t find much info on Calcipotriol and scarring alopecia. Thanks

[@donovanmedical9780]

It can have mild benefits but for most patients with FD the credit would need to go to the clarithromycin/Bactrim. But yes, vitamin D analogues can benefit a variety of neutrophilic and acneiform based lesions - including acne and psoriasis.

[@guillermorivera6332]

@@donovanmedical9780 Thanks !

[@copetillirope178]

great video . i have acess to the cream brand name opzelura do you think it will be as usefull as the jak used in the study? and sorry to ask but according to you in lpp what has the best potential for regrowth inbetween cyclosporine / oral jak / or otezla ? so far it's the three med i've seen giving regrowthon some patient even on somewhat scarred area. thank you very much

[@donovanmedical9780]

Well, of those 3 drugs, cyclosporine has the best long term data but they are all somewhat useful. All these drugs have different safety and cost and therefore need to be reviewed one by one. We don’t have data comparing topical tofa to topical ruxo but likely there a similar. But we just don’t have good data to say anything more than that.

[@copetillirope178]

@@donovanmedical9780 ​ @donovanmedical9780 thank you so much for your answer i was under the impression oral jak were safer than cyclo to use long term . sorry to bother you but would you say than otezla is less powerfull monotherapy in term of results than oral jak or cyclo in your experience?

[@copetillirope178]

Thank you so much doc. I know i'm harassing you under your videos and really appreciate your answer and learning on thos disease. As i'm french is there a way for me to get an opinion on my brows lpp or possible ffa through photos? I will pay whatever the cost is to have an opinion . I sent you a message on your instagram i know it's not how a patient should behave and i apologize but i don't think it's possible for me to reach your secretary on your online website