Sequential Small-Molecule Therapy for Lymphocytic Cicatricial Alopecia: A Multicenter Prospective Cohort Pilot Study

This multicenter prospective cohort pilot study evaluated a three-stage sequential small-molecule therapy for active lymphocytic cicatricial alopecia (LCA) in 33 patients, with 31 completing the regimen. The treatment involved oral Tofacitinib and topical Crisaborole (Stage I), oral Apremilast and topical Crisaborole (Stage II), and topical Crisaborole alone (Stage III). Results showed a significant decrease in the Lichen Planopilaris Activity Index (LPPAI) from 5.65 ± 1.45 to 0.75 ± 0.27, with an 85.5% improvement rate (P < .001) by Stage III. Notably, 93.5% of patients experienced marked improvement, and only 3 mild adverse events were reported. Despite limitations such as a small sample size, lack of a control group, and short follow-up, the regimen was well tolerated and presents a promising treatment option for active LCA.