International Journal of Preventive Medicine (Int J Prev Med)2008-7802042017052717941794ENDepartment of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, IsfahanDepartment of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, IsfahanDepartment of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, IsfahanDepartment of Biostatics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan20170527<p><strong><span class="fontstyle0">Background: </span></strong><span class="fontstyle2">Lichen planopilaris is an inflammatory cicatricial alopecia, and its management is a challenge for dermatologists. We aimed to compare the effcacy of methotrexate and hydroxychloroquine on refractory lichen planopilaris. </span></p><p><strong><span class="fontstyle0">Methods: </span></strong><span class="fontstyle2">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,&nbsp; 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. </span></p><p><span class="fontstyle0"><strong>Results</strong>: </span><span class="fontstyle2">After 2 months, mean (standard deviation [SD]) decrease in LPPAI in methotrexate group was signifcantly more than that in hydroxychloroquine group (1.68 [1.24] vs. 0.8 [0.71], respectively, </span><span class="fontstyle3">P </span><span class="fontstyle2">= 0.047). Furthermore, after 6 months, mean (SD) decrease in LPPAI in methotrexate group was signifcantly higher than that in&nbsp; hydroxychloroquine group (3.3 [2.09] vs. 1.51 [0.91], respectively, </span><span class="fontstyle3">P </span><span class="fontstyle2">= 0.01). The following symptoms/signs showed signifcant improvements in frequency and/or severity in methotrexate group after intervention: pruritus (</span><span class="fontstyle3">P </span><span class="fontstyle2">= 0.007), erythema (</span><span class="fontstyle3">P </span><span class="fontstyle2">= 0.01), perifollicular erythema (</span><span class="fontstyle3">P </span><span class="fontstyle2">= 0.01), perifollicular scaling (</span><span class="fontstyle3">P </span><span class="fontstyle2">= 0.08), spreading (</span><span class="fontstyle3">P </span><span class="fontstyle2">= 0.001), and<br />follicular keratosis (</span><span class="fontstyle3">P </span><span class="fontstyle2">= 0.04). In hydroxychloroquine group, only erythema (</span><span class="fontstyle3">P </span><span class="fontstyle2">= 0.004) showed signifcant improvement. </span></p><p><strong><span class="fontstyle0">Conclusions: </span></strong><span class="fontstyle2">Methotrexate was more effective than hydroxychloroquine in<br />treating refractory lichen planopilaris.</span></p><p><strong><span class="fontstyle0" style="color: #00652e;">Keywords: </span></strong><span class="fontstyle3">Hydroxychloroquine, lichen planopilaris, methotrexate</span> <br style="font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px;" /></p>http://ijpm.mui.ac.ir/index.php/ijpm/article/view/1794http://ijpm.mui.ac.ir/index.php/ijpm/article/download/1794/2079