THERAPEUTIC HOTLINE: Effectiveness of the association of cetirizine and topical steroids in lichen planus pilaris - an open-label clinical trial

Abstract

Lichen planus is considered a T cell-mediated immunological disease. Even mast cells may contribute to the pathogenesis of the disease. Keratinocytes of the basal layer of the skin and/or the hair follicle may represent the "target/victim" of an immune aggression, determining the destruction of the hair follicle and thus scarring alopecia. Therefore, there is a compelling urgency for effective treatment of this potentially disfiguring dermatosis. Our data provide a further therapeutic opportunity: the use of an antihistaminic drug--cetirizine (CTZ)--in an "anti-inflammatory" regimen. We propose the use of CTZ at the dosage of 30 mg/daily. Twenty-one patients affected by lichen planus pilaris (LPP) of the scalp have been treated. Topical application of steroids has been coadministered in all cases during the therapy. Clinical effects, in the sense of stabilization with cessation of the inflammation (erythema, follicular hyperkeratosis, loss of anagen hair), were achieved in all patients but three. One patient developed cardiac arrhythmia after 3 months of successful treatment and dropped out. Our cases indicate that a combined therapy of topical steroid with CTZ can be a safe and effective choice even in severe cases of lichen planus pilaris, so often refractory to the therapy.

Profiling the human hair follicle immune system in lichen planopilaris and frontal fibrosing alopecia: can macrophage polarization differentiate these two conditions microscopically?

“…Degranulated MCs around the bulge (in mice) are identified as critical ‘cellular switchboards’ of neurogenic skin inflammation and immune privilege collapse, with MCs also regulating antigen‐specific (auto)immune responses of CD8 + T cells . We show increased total numbers and degranulation status of perifollicular MCs in lesional LPP and FFA HFs compared with control samples, supporting the role of MCs in scarring alopecia . Interestingly, a significant increase in perifollicular MCs and a phenotypic switch from an immunoinhibitory to a proinflammatory phenotype is reported in alopecia areata, and MC–T‐cell interactions have become a major focus in autoimmune disease research .…”

“…Therefore, MCs may hold promise as therapeutic targets in LPP and FFA, although the clinical evidence currently supporting this approach is limited. 53 The increased numbers of CD68 + cells identified in our analyses led us cautiously to assign these cells as macrophages, and suggest they play an important role in the pathogenesis of LPP and FFA. These cells were particularly prominent in partially destroyed HFs, supporting their function as scavenging phagocytes.…”

“…51 We show increased total numbers and degranulation status of perifollicular MCs in lesional LPP and FFA HFs compared with control samples, supporting the role of MCs in scarring alopecia. [52][53][54] Interestingly, a significant increase in perifollicular MCs and a phenotypic switch from an immunoinhibitory to a proinflammatory phenotype is reported in alopecia areata, 55 and MC-T-cell interactions have become a major focus in autoimmune disease research. 51,[55][56][57] We show increased MC-T-cell interactions in LPP, suggesting a role for MCs in Tcell activation.…”

“…We show increased MC–T‐cell interactions in LPP, suggesting a role for MCs in T‐cell activation. Therefore, MCs may hold promise as therapeutic targets in LPP and FFA, although the clinical evidence currently supporting this approach is limited …”

Frontal fibrosing alopecia: An update on the hypothesis of pathogenesis and treatment

“…Due to the possible role of mast cells in LPP and the capacity of cetirizine to reduce the number of tryptase-positive mast cells (Pestelli et al, 2001), combined therapy with cetirizine at a dosage of 30 mg/day and a topical steroid agent was suggested as a valid option for the treatment of LPP (d'Ovidio et al, 2010), and can ameliorate pruritus in these patients, which is a common finding.…”