P16 TREATMENT OF PSEUDOPELADE WITH ACITRETIN OR THALIDOMIDE : AN OPEN STUDY IN 17 PATIENTS.

C. Jouanique, P. Assouly, B. Matard, P. Reygagne. Hôpital Saint-Louis, Centre Sabouraud, 2 place du Dr A. Fournier, 75010 Paris, France.

Treatment of pseudopelade is difficult. We have treated 17 patients having a progressive pseudopelade with acitretin or thalidomide, two treatments effectives in discoid lupus erythematosus and in lichen planus, the main etiologies of pseudopelade. In all patients, scalp biopsies with immunofluorescence studies and antinuclear antibodies titter were performed. There were 12 cases of lichen plano-pilaris, 3 cases of pseudopelade de Brocq. In 2 cases, the differential diagnosis was impossible between  lichen planus and lupus. Patients were treated by acitretin 30 mg/day or by thalidomide 100 to 200 mg/day for 6 months. Treatment selection depended on each patient contra-indication. Eleven patients were treated by acitretin (8 lichen plano-pilaris, 1 pseudopelade de Brocq, 2 lupus-lichen), 6 were treated by thalidomide (4 lichen plano-pilaris, 2 pseudopelade de Brocq). Patients were examined after 1 month, 2 months, 4 months and 6 months of treatment. At each visit, photographs of scalp hairs were taken for hair counts and global photographies for clinical investigator assessment. Patients treated with thalidomide had electromyogramme before and after treatment. Efficacity was evaluated by investigator assessment using global photographies and by scalp hair counts. With acitretin, 7/11 patients were clinically rated as worsened, there was no change for 4/11 patients. No patient was rated as improved. Hair counts demonstrated a decrease for 8/11 patients and the average of hair count decrease was 26 % at the end of the 6 months. With thalidomide, 2/6 patients were clinically rated as worsened, 2/6 patients were rated as unchanged, 2 were lost to follow-up. Hair counts demonstrated a decrease for all patients. The average of hair counts decrease was 9,4% at month 6. Tolerability of both treatments was poor. With acitretin, telogen effluvium was constant. One case of neuropathy occured with thalidomide. This study concernes a small number of patients, but  acitretin doesn’t stop the progression of hair loss in patients with pseudopelade. We need more patients to conclude about thalidomide.