Dear Doctor
Over a year ago I found out that I have LPP and FFA. Right now I am on Plaquenil. I also use Clobetasol and Rogaine.
Before I was also getting scalp injections and I was on Doxycycline. Doxy worked fine for a month but later I started having stomach problems and stopped it.
At this time I am still loosing hair. I know there are other medications used to treat LPP such as Cellcept, Cyclosporine or Actos. Some doctor I have seen tell me they would be an over kill.
I want to mention that 5 years ago I had brain tumor. Would these medications be a bad idea for someone who had a tumor? Would these medications be a bad idea in general?
I don’t want to loose the rest of my hair but I also don’t want to risk my health. Thank you in advance for your help.
Dear Patient
Mycophenolate Mofetil Side Effects
Mycophenolate mofetil is an immunosuppressant which is used to treat LPP (lichen planopilaris) since it modifies the inflammatory response of the immune system.
From your picture and history of having had a brain tumor, I would not recommend using Mycophenolate mofetil to treat your case of LPP and FFA (frontal fibrosing alopecia). This is due to the fact that side effects of mycophenolate mofetil include developing tumors like melanomas, lymphomas and other malignancies.
Cyclosporine Side Effects
Cyclosporine is also another immunosuppressant used to treat refractory cases of LPP. I would also not recommend using cyclosporine for your case of LPP and FFA because of your history and presentation. In addition, it has also been associated with an increased risk of developing tumors especially in transplant patients.
Pioglitazone Side Effects
Pioglitazone is a peroxisome proliferator–activated receptor γ (PPAR-γ) agonist which is used to treat LPP since studies suggest that abnormal functioning of these receptors can trigger the inflammatory response that causes LPP. Side effects of pioglitazone include bladder cancer. Though it is not an immunosuppressant, from your history I would recommend other treatments before suggesting pioglitazone.
Recommendations
I would have liked to know how long you have been on Hydroxychloroquin (Plaquenil) since it has a slow onset of action and it can take 2 to 3 months before its effects are seen.
If you have been on hydroxychloroquin for less than 3 months, I suggest you visit your nearest dermatologist and get a prescription of a systemic glucocorticoid like Prednisone since it is used as bridge therapy while waiting for the effects of hydroxychloroquin to set in.
In addition I would also recommend using antiseborrheic shampoo with ketoconazole to your hair care regimen.
Conclusion
Mycophenolate mofetil, cyclosporine and pioglitazone are not a “bad idea in general” since they are used to treat many patients with classic lichen planopilaris and frontal fibrosing alopecia.
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