Igor Kapetanovic

Summary: Background and objectives: Pioglitazone is an underused drug in lichen planopilaris (LPP) with limited prospective evidence. This study investigated the therapeutic efficacy and safety profile of pioglitazone compared with hydroxychloroquine. Patients and methods: This reviewer‐blinded, prospective non‐inferiority study was conducted at a tertiary university hospital in Belgrade, Serbia, between October 2023 and January 2025. Patients with LPP affecting < 20 % of the scalp received pioglitazone (exposed cohort), whereas those with > 20 % scalp involvement received hydroxychloroquine (HCQ; control cohort). Patients were evaluated at baseline and after 3 and 6 months. The primary outcome measures were the Lichen Planopilaris Activity Index (LPPAI) and Global Photographic Assessment (GPA). Results: In total, 82 consecutive patients (42 pioglitazone, 40 HCQ) were enrolled. 66 patients (80.49 %) were analyzed using a per‐protocol approach. The mean LPPAI at baseline and last session were 3.32 ± 1.23 and 0.95 ± 0.74 in the pioglitazone group and 3.64 ± 1.46 and 1.13 ± 0.9 in the hydroxychloroquine cohort, respectively. No significant difference in LPPAI reduction (p = 0.66) was observed between cohorts. Pioglitazone prevents disease progression in 87.5 % cases. No statistical difference between cohorts in GPA score was seen (p = 0.98). Both treatment options were well‐tolerated (p = 0.73). Conclusions: This study provides the largest prospective pioglitazone cohort reported to date in LPP and demonstrates that pioglitazone is non‐inferior to hydroxychloroquine as a first‐line systemic treatment, while also exhibiting a strong safety profile.

Introduction: Isotretinoin-induced hematuria is very rare; it has been reported in one study and individual case reports but never proven statistically. Objectives: To determine whether hematuria is statistically more significant in isotretinoin-treated acne patients than in non-isotretinoin-treated patients. Methods: Cohort study of acne patients treated at the University Clinic of Dermatology between 01 September 2022 and 31 March 2024. Results: Eight hundred and sixty-four acne patients were treated and reviewed; 69.3% (599/864) were treated with modalities other than isotretinoin, while 30.7% (265/864) were treated with isotretinoin. Of the isotretinoin patients, only 26% (69/265) had urinalysis done at least once during therapy. In the isotretinoin group, 13% (9/69) had at least one episode of hematuria during treatment, as did 2.9% (2/70) in the control group. Hematuria is significantly more frequent in the isotretinoin group compared to control (P=0.026), with a 5.1 (95% confidence interval (CI): 1.06–24.5) higher risk. Of the isotretinoin-induced hematuria patients, 66.6% were male. The mean duration of isotretinoin use for hematuria was 2.78 months. Comorbidities and minimal and maximal isotretinoin dosage were not correlated with hematuria. Conclusion: Hematuria is significantly more frequent in patients on isotretinoin and is a side-effect of isotretinoin. In the majority of cases, isotretinoin should be continued. Patients should be stratified according to risk factors per guidelines for microhematuria and referred to urologists. Urinalysis should be a part of routine monitoring in patients on isotretinoin especially at the 2- and 4-month intervals.