Response of Lichen Planopilaris to Pioglitazone Hydrochloride

December 2019 | Volume 18 | Issue 12 | Case Reports | 1276 | Copyright © December 2019

Erik L. Peterson BS, Daniel Gutierrez MD, Nooshin K. Brinster MD,
Kristen I. Lo Sicco MD, Jerry Shapiro MD

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY

investigation found that the two most common polymorphisms of the PPAR- γ gene, Pro12Ala and Pro12Pro, are not associated with differing response rates to pioglitazone in vivo.14 Thus, while it is clear that some individuals demonstrate decreased response to therapy with pioglitazone, factors determining response remain uncertain. Further randomized controlled trials are necessary to understand the true mechanism and efficacy of this therapeutic modality.

The findings of this study are limited by several factors. This was a retrospective study, without a control population, which evaluated patients on several concurrent immunosuppressive therapies. Therefore, patient improvement may not be due solely from pioglitazone itself, but rather a function of continued use of concurrent medications on other medications or spontaneous resolution. Furthermore, patient evaluation and assessment of disease activity was based on one provider’s clinical expertise.


Pioglitazone is a beneficial adjunctive therapy in the treatment of LPP, as supported by 78% of patients who demonstrated significant improvement in disease activity with the addition of pioglitazone to their therapeutic regimen. For a subset of patients, the addition of pioglitazone to their therapeutic regimen represented a key step toward stabilization, after being recalcitrant to all other first line therapies. These findings, in accordance with current literature supporting the role of PPAR- γ in cicatricial alopecia, suggest that pioglitazone’s mechanism of action may combat a key contributor in the pathogenesis of LPP. However, given mixed evidence in current literature regarding pioglitazone’s efficacy, a prospective, randomized trial evaluating the treatment of LPP with pioglitazone as the sole therapeutic agent is necessary to confirm or refute its potential beneficial effect.


The authors have no conflict of interest to declare.



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