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Minoxidil as an adjunct to methotrexate and clobetasol in lichen planopilaris

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Created On: 14/07/2025

Managing lichen planopilaris (LPP; main cause of scarring alopecia) poses a key challenge for dermatologists.

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Key take away

Adding low-dose oral minoxidil (1 mg/day) to standard lichen planopilaris treatment is safe and improves certain symptoms like pain and burning. However, it does not significantly affect LPPAI scores or hair regrowth.

Background

Managing lichen planopilaris (LPP; main cause of scarring alopecia) poses a key challenge for dermatologists. Beyond controlling inflammation, a key treatment objective is enhancing hair thickness in unaffected regions to better conceal scarring. This study was carried out to explore the efficacy and safety of incorporating low-dose oral minoxidil into the standard anti-inflammatory regimen for refractory and/or severe LPP.

Method

In this randomized clinical trial, 37 LPP patients were randomly divided into two groups: one received methotrexate (15 mg/week) + topical clobetasol, while the other received the same combination plus oral minoxidil (1 mg/day) for about 6 months. Treatment response was monitored using the Lichen Planopilaris Activity Index (LPPAI), dermoscopic evaluation, and standardized photography.

Result

Both groups demonstrated prominent reductions in LPPAI scores (p < 0.001). Improvements were observed in several clinical signs and symptoms across both groups, including pruritus, positive anagen pull test, follicular prominence, scalp and perifollicular erythema, milky red areas, and pigmentation. However, only the group receiving methotrexate + clobetasol + minoxidil reported relief from pain, burning, hair tufting, and disease spread.

No change was noted in elongated blood vessels in either group. Interestingly, 2 of 19 patients in the minoxidil group (10.5%) experienced regrowth in scarred areas. While improvements in hair thickness and density were observed, the difference between groups was not statistically significant.

Conclusion

Supplementing standard LPP therapy with 1 mg/day oral minoxidil appeared to be a safe approach but did not offer significant additional benefits in reducing disease activity or enhancing hair density. Further research exploring higher minoxidil doses is warranted.