Adding 1 Miligram to Standard Minoxidil Treatment Ineffective for Lichen Planopilaris

Credit: Pexels

New findings suggest the addition of 1 mg per day minoxidil to standard lichen planopilaris treatment, while safe, does not result in a significant impact on Lichen Planopilaris Activity Index (LPPAI) or density/thickness of hair.¹

These data were authored by a team of investigators led by Mina Saber, from the department of dermatology at Isfahan University of Medical Sciences Skin Diseases and Leishmaniasis Research Center. Saber et al. sought to assess the efficacy and safety of additional low-dose oral minoxidil for patients with lichen planopilaris, a form of alopecia.

Prior data cited by Saber and colleagues have indicated the benefits of topical and low-dose oral minoxidil for maximizing patients’ hair regrowth, especially among individuals who face inherited pattern alopecia.²

“In this randomized controlled study, we evaluated the effectiveness and safety of adding low-dose [oral minoxidil] to the standard treatment with [methotrexate] in patients with refractory and/or severe [lichen planopilaris],” Saber and colleagues wrote.¹

Impact of Added Oral Minoxidil for Lichen Planopilaris

The investigators conducted their analysis at a dermatology clinic affiliated with Isfahan University of Medical Sciences (IUMS) in the timeframe between July 2022 - January 2024. They evaluated individuals between the ages of 20 - 65 years, excluding those over the age of 65 given the potential influence of systemic senescence effects on the therapeutic response to methotrexate and low-dose oral minoxidil.

For inclusion in their research, the investigative team required participants to have a confirmed clinical and histological lichen planopilaris diagnosis and meet specific eligibility criteria. These criteria included having persistent disease despite prior therapies, newly active disease, and a lack of topical or systemic medication use for 2 months minimum prior to enrollment.

All of those included as trial subjects underwent a thorough physical examination in their initial meeting, during which the team conducted assessments of the subjects' body weight, blood pressure, and the skin, mucosa, and nails. Additionally, the investigators carried out laboratory tests.

These tests included liver, hematologic, and renal function assessments, as well as pregnancy tests for women who were of childbearing age. Routine monitoring, given potential toxicity of methotrexate, continued throughout the analysis to allow for patient safety.

The research team assigned 37 participants with lichen planopilaris randomly to 1 of 2 possible treatment cohorts. In 1 cohort, those included were given a weekly dose of 15 mg of methotrexate along with topical clobetasol. In the second cohort, those included were given the same methotrexate and clobetasol regimen with the addition of 1 mg of oral minoxidil on each day.

Over a 6-month period, the treatments were administered. The team evaluated efficacy using dermoscopic analysis, the Lichen Planopilaris Activity Index (LPPAI), and standard clinical photography.

Overall, the study's findings showed that both treatment arms were shown to have significant reductions participants' LPPAI scores (P < .001), signifying improvement in overall disease activity among these subjects. Improvements in patients' symptoms, including follicular prominency, itch, scalp erythema, perifollicular erythema, and pigmentation, were observed in both cohorts.

The investigators further highlighted that the frequency and severity of positive anagen pull tests had been shown to decrease. Despite such results, the analysis indicated that improvements in burning sensations, pain, hair tufting, and disease spreading only took place among individuals being treated with methotrexate combined with low-dose oral minoxidil.

Thickness and density of patients' hair was noted as similar between the 2 cohorts, and the team found no statistically significant distinctions. Neither of the treatment arms resulted in significant changes in subjects' elongated blood vessels.

The analysis also established criteria for withdrawal among patients, which included failure to attend follow-up appointments, use of further topical or systemic therapies in the trial period, pregnancy, noncompliance with the prescribed regimen, or the occurrence of severe drug-induced adverse effects.

“While our study did not reveal significant benefits from adding low-dose [oral minoxidil] to standard treatment, previous research indicating promising effects of low-dose [oral minoxidil] has provided insights into the treatment of [lichen planopilaris],” they wrote. “Given that we are still in the early stages of applying low-dose [oral minoxidil] in [lichen planopilaris], further research will be necessary to draw definite conclusions.”^1,3

References

1. Saber, Mina, Dehghani, Shaghayegh, Fatemi Naeini, Farahnaz, Mohaghegh, Fatemeh, Low-Dose Oral Minoxidil in Lichen Planopilaris: Efficacy and Safety, Dermatologic Therapy, 2025, 1323718, 13 pages, 2025. https://doi.org/10.1155/dth/1323718.

2. Plante J., Eason C., Snyder A., and Elston D., Commentary: A Stepwise Approach to the Treatment of Lichen Planopilaris, Journal of Dermatology and Skin Science. (2020) 2, no. 2.

3. Beach R. A., Case Series of Oral Minoxidil for Androgenetic and Traction Alopecia: Tolerability & the Five C′s of Oral Therapy, Dermatologic Therapy. (2018) 31, no. 6, https://doi.org/10.1111/dth.12707, 2-s2.0-85053827248.