Lichen planopilaris (LPP) doesn’t get talked about nearly as much as other types of hair loss, but anyone who has it knows how hard it is to ignore. Along with pain, burning and itching on the scalp, this form of inflammatory scarring alopecia causes permanent scarring and hair loss. There’s also never been an FDA-approved systemic treatment for it. That may be starting to change.
As reported by Dermatology Times, a recently announced phase 2/3 trial will test brepocitinib, an oral Janus kinase (JAK) inhibitor, in patients with moderate to severe LPP. If it works, it could become the first FDA-approved systemic therapy for the condition.
Taking Aim at Scarring Hair Loss ‘From the Inside Out’
New York dermatologist Kristen Lo Sicco, MD, associate professor of dermatology at the Ronald O. Perelman Department of Dermatology at NYU Langone Health, explained that the JAK-STAT pathway plays a key role in the inflammation behind LPP. Brepocitinib is designed to calm that pathway. Earlier research supports the approach, including studies of topical JAK inhibitors in frontal fibrosing alopecia, a related condition.
Because it’s taken by mouth, the drug could treat the disease “from the inside out,” which may matter most for patients whose LPP is more extensive or hasn’t responded to other treatments. Brepocitinib has already shown success in two other rare conditions, dermatomyositis and cutaneous sarcoidosis.
Who the Trial Is For (and What Counts as a Win)
The study focuses on moderate to severe LPP. Patients need both symptoms, like itching, pain, burning or abnormal scalp sensations, and visible signs of inflammation, like redness and scaling around the hair follicles. Those signs are checked during a clinical exam and with trichoscopy, a magnified view of the scalp.
Success will be measured with a new, validated Investigator Global Assessment (IGA) built just for LPP. The goal is for patients to reach quiet or nearly quiet disease, along with real symptom relief, after six months of treatment. The IGA was developed to meet FDA standards for a possible approval, and the Lichen Planopilaris Activity Index will be tracked as a secondary measure.
So, What About Those JAK Warnings?
Oral JAK inhibitors carry boxed warnings, so safety came up too. Lo Sicco cited a meta-analysis that found no statistically significant increase in major heart-related events or blood-clot risk among dermatology patients taking JAK inhibitors. She added that choosing the right patients still matters and that longer-term data is needed.
Bonus Perk: Less Waiting on Insurance
Lo Sicco also sees a practical upside beyond the science. An approval could shorten the insurance delays doctors have already run into with JAK inhibitors for alopecia areata.
“I’m really hoping that the FDA approval will help to break down some barriers regarding timely insurance approval,” she said. “So that means a short period of time between me putting in the prescription and the patient actually getting the medication in their hands. Like we said, time is of the essence.”
While the trial gets underway, Lo Sicco points to the Scarring Alopecia Foundation as a resource for learning about LPP and the treatments in development.
