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Background:Lichen planopilaris is an inflammatory cicatricial alopecia, and its management is a challenge for dermatologists. We aimed to compare the efficacy of methotrexate and hydroxychloroquine on refractory lichen planopilaris.Methods:In a randomized clinical trial, 29 patients were randomly allocated to receive either 15 mg methotrexate/week or 200 mg hydroxychloroquine twice a day for 6 months. Side effects, symptoms/signs, and laboratory tests were assessed periodically. Lichen Planopilaris Activity Index (LPPAI) was measured before intervention and at 2, 4, and 6 months after. The changes from baseline to the end of the study were analyzed within each group and between the two groups by per-protocol and intention-to-treat analysis.Results:After 2 months, mean (standard deviation [SD]) decrease in LPPAI in methotrexate group was significantly more than that in hydroxychloroquine group (1.68 [1.24] vs. 0.8 [0.71], respectively, P = 0.047). Furthermore, after 6 months, mean (SD) decrease in LPPAI in methotrexate group was significantly higher than that in hydroxychloroquine group (3.3 [2.09] vs. 1.51 [0.91], respectively, P = 0.01). The following symptoms/signs showed significant improvements in frequency and/or severity in methotrexate group after intervention: pruritus (P = 0.007), erythema (P = 0.01), perifollicular erythema (P = 0.01), perifollicular scaling (P = 0.08), spreading (P = 0.001), and follicular keratosis (P = 0.04). In hydroxychloroquine group, only erythema (P = 0.004) showed significant improvement.Conclusions:Methotrexate was more effective than hydroxychloroquine in treating refractory lichen planopilaris.

cSLE survival in Iran was comparable to that in other developing countries. Baseline presentation with hematuria predominantly increased the mortality rate in cSLE. Prospective and larger studies in future may unfold other aspects of cSLE.

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Background Solar lentigo (SL) is a benign hyperpigmented spot occurring due to ultraviolet exposure, most commonly in the elderly. We aimed to compare the safety and efficacy of trichloroacetic acid (TCA) peeling with Q‐switched laser in the treatment of SLs. Methods This assessor‐blind split‐hand randomized controlled trial included 45 patients with symmetric SLs on the back of their hands referred to the dermatology clinics from March 1 to June 24, 2021. TCA 35% was applied to the back of one hand, and the contralateral hand received Q‐switched laser. The interventions were repeated for a total of three sessions 4 weeks apart. Eight weeks after the last treatment session, lesion lightening was graded from 1 to 4. Patient satisfaction with treatment was assessed using a visual analogue scale (VAS). Adverse events were also noted. Results Of the 45 patients included in the current study with a mean age of 52.71 ± 9.73 years, 11 (24.4%) were male. The Fitzpatrick skin type was II in 11 patients (24.4%), III in 23 (51.1%), and IV in 11 (24.4%). Lesion lightening and patient satisfaction were both significantly better with Q‐switched laser compared to TCA peeling (standardized mean difference [SMD] = −1.25, 95% confidence interval [CI] ‐1.69; −0.79, p < 0.001 and SMD = ‐1.12, 95% CI ‐1.56; −0.67, p < 0.001, respectively). Overall, post‐inflammatory hyperpigmentation (PIH) occurred in one patient in the laser group and for in the TCA group. Also, erythema and pruritus were observed in all patients of both groups after intervention which were treated with topical repair cream. Conclusions Q‐switched laser was superior to TCA peeling for the treatment of SLs in terms of lesion lightening and patient satisfaction with a large effect.