Pediatric Lichen Planopilaris Treated With Pioglitazone: A Case Study and Literature Review

July 2021 | Volume 20 | Issue 7 | Case Reports | 779 | Copyright © July 2021

Published online June 28, 2021

Ana Preda-Naumescu BS, Stephanie L. Bevans MD, Tiffany T. Mayo MD

University of Alabama at Birmingham, Birmingham, AL

Importance: Pediatric lichen planopilaris (LPP) is a clinical variant of lichen planus (LP) that can lead to scarring hair loss without prompt intervention. While various therapies exist, intralesional and topical corticosteroids remain the mainstay of treatment in pediatric LPP. Refractory cases may require systemic therapies, selection of which may prove challenging due to the lack of data regarding pediatric disease and effective treatment regimens. The objective of this case study is to present a new instance of pediatric LPP and identify all reported cases of pediatric LPP with an emphasis on treatment and response.

J Drugs Dermatol. 2021;20(7):779-782. doi:10.36849/JDD.5729


Lichen planus (LP) is an inflammatory papulosquamous dermatosis occurring in children in only 10–11% of cases.1 Lichen planopilaris (LPP) is a clinical variant of LP that demonstrates lymphocytic scarring alopecia.2 It is relatively uncommon in children, accounting for only 6.3% of reported childhood LP cases.3 Clinically, centrifugally growing plaques favoring the parietal and/or occipital scalp with perifollicular scaling and absence of follicular ostia are accompanied by pruritus and hair loss.2

Treatment for LPP poses a challenge for dermatologists. While several treatments are available and have indeed demonstrated clinical value, varying levels of patient improvement with these regimens suggests that the treatment algorithm for LPP is still largely undetermined.3

We describe a case of LPP in an African American adolescent treated with pioglitazone, accompanied by a literature review of published LPP cases in the pediatric population.


The patient is a 15-year-old African American male with history of atopy, psoriatic arthritis, ankylosing spondylitis, and prediabetes who presented to dermatology clinic for a five-year history of scarring alopecia initially manifesting as pain, pruritus, and scale. Treatments prior to presentation included clobetasol 0.05% foam daily to the scalp with minimal improvement. Patient’s medications for his additional comorbidities included methotrexate, etanercept, and metformin.

Physical exam revealed perifollicular plugging and erythema of the lateral eyebrows and posterior vertex scalp along with scarring of the anterior vertex scalp evidenced by absence of follicular ostia (Figure 1). Biopsy was deferred as physical exam and dermoscopy findings were consistent with LPP. He was initiated on clobetasol 0.05% foam daily to involved areas of the scalp, tacrolimus 0.1% ointment daily to the brows and face, and doxycycline monohydrate 100 mg twice daily. In addition, he received intralesional Kenalog (ILK) injections to the affected scalp and eyebrows.