Líquen plano hipertrófico disseminado: relevante resposta à acitretina

Abstract

Hyperthrofic lichen planus is considered a variant of lichen planus with marked epidermal hyperplasia in response to persistent itch. It is clinically, characterized by symmetric hyperkeratotic plaques, of purplish-grey color, often located in the pretibial region. Intense pruritus, refractoriness to conventional treatments and the possibility of association of the long-term injuries with squamous cell carcinoma requires an effective treatment. The first-line treatment is corticosteroids which can be applied either topically or systemically. Other therapeutic modalities proposed are: NB-UVB phototherapy or PUVA, immunosuppressive drugs and systemic retinoids, notably acitretin. We report a case with exuberant clinical presentation of hyperthrofic lichen planus with excellent response to acitretin after nine months of treatment. Keywords: Acitretin; Immunosuppressive drugs; Lichen planus; Prednisone Resumo: O líquen plano hipertrófico é uma variante do líquen plano, com pronunciada hiperplasia epidér-mica em resposta à coçadura persistente. Clinicamente, caracterizam-se por placas hiperceratósicas, simétri-cas, de coloração cinza-violácea, com predileção pela região pré-tibial. O prurido intenso, a refratariedade aos tratamentos convencionais e a possibilidade de associação de um carcinoma epidermoide às lesões de longa duração impõem um tratamento eficaz. Os corticoides são considerados o tratamento de primeira linha e podem ser aplicados topicamente ou empregados de forma sistêmica. Outras modalidades terapêu-ticas propostas são a fototerapia com UVB-NB ou PUVA, imunossupressores e retinoides sistêmicos, com destaque para a acitretina. Relatamos um caso com apresentação clínica exuberante e excelente resposta à acitretin, totalizando um seguimento de nove meses.

Update on lichen planus and its clinical variants

“…Successful treatment has been achieved with mycophenolate mofetil, acitretin, and intralesional steroid injections in combination with cryotherapy (Jaime et al, 2011, Nousari et al, 1999, Wagner et al, 2013). Low-dose low-molecular-weight heparin may be effective, but more evidence is needed before use of this treatment becomes commonplace (Rai et al, 2002).…”

A single case study of treating hypertrophic lichen planus with Ayurvedic medicine

“…[ 6 ] Most recent conventional treatment of the HLP and LP disorders consists the use of topical and systemic corticosteroid, psoralen and ultraviolet A therapy, immunosuppressant, systemic retinoid, cyclosporine, and acitretin. [ 7 8 ] All these drugs are proved to reduce the symptoms temporarily. In Ayurveda, this condition may be considered under Charma Kushtha , a type of Kshudra Kushtha (minor skin diseases), due to the similarity in signs and symptoms with HLP.…”