Adverse outcome of methotrexate and mini pulse betamethasone in the treatment of lichen planus

Hazra, Samaresh Chandra; Choudhury, A M; Asaduzzaman, Akm; Paul, Harasit Kumar

doi:10.3329/bmrcb.v39i1.15806

Cited by 12 publications

(8 citation statements)

References 14 publications

(3 reference statements)

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“…However, those differences were not statistically significant . This dosage of methotrexate (10 mg weekly) was compared to ‘mini‐pulse therapy’ of betamethasone (5 mg daily for two consecutive days) in a 12‐week study: authors concluded that methotrexate presented with better clinical outcomes, but differences were not statistically significant …”

Section: Methotrexatementioning

confidence: 97%

Lichen planus: a comprehensive evidence‐based analysis of medical treatment

Husein‐ElAhmed

Gieler

Steinhoff

2019

Acad Dermatol Venereol

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Lichen planus (LP) is a chronic-relapsing inflammatory skin disease. Although many drugs have been used for the management of LP, some of them lack the backup by strong therapeutic evidence, while others are not suitable for some patients due to safety profile issues. The aim of this study was to review the recent status of available medical therapies for LP to help physicians make better decisions upon best medical practice while facing patients with this condition. A review of published articles on management of LP was conducted with the MEDLINE and PubMed databases. The quality of the evidence was graded as high, moderate, low or very low. A total of 1366 articles were retrieved, and 219 (16%) were included in the final analysis. Twenty-one different treatment modalities were analysed. The quality of evidence was high for topical steroid and calcineurin inhibitor, while it was moderate for oral steroids. All the other modalities reached low or very low quality of evidence. Topical steroids and calcineurin inhibitors are the current first-line therapies, while for other therapies the strength of recommendation is not so evident. Unfortunately, larger randomized, controlled trials to support the efficacy, safety and tolerability of other therapies in LP are lacking, and many of them are recommended based on studies with small sample sizes, lack of standardized outcome measures or lack of controlled duration or even in anecdotal evidence. Thus, large-scale randomized clinical trials are still warranted to establish the exact benefits of other topical treatments, phototherapy, immunosuppressant and new immunomodulators for an optimized treatment of LP.

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Section: Methotrexatementioning

confidence: 97%

Lichen planus: a comprehensive evidence‐based analysis of medical treatment

Husein‐ElAhmed

Gieler

Steinhoff

2019

Acad Dermatol Venereol

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“…As the role of CD4 and CD8 T cells in the pathogenesis of LP is important, it can be assumed that methotrexate should be effective in LP. Methotrexate has been recently tried in cutaneous (Kanwar & De, ; Turan, Baskan, Tunali, Yazici, & Saricaoglu, ), oral (Hazra, Choudhury, Khondker, & Khan, ; Torti, Jorizzo & McCarty, ), erosive vulvovaginal LP (Jang & Fischer, ; Kortekangas‐Savolainen & Kiilholma, ) and LP pemphigoides (Duong, Marks, Sami, & Theos, ) wherein it was found effective. However, evidence for efficacy of methotrexate in OLP is not robust and it has not been compared with the present gold standard, that is topical corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

A prospective observational study to compare efficacy of topical triamcinolone acetonide 0.1% oral paste, oral methotrexate, and a combination of topical triamcinolone acetonide 0.1% and oral methotrexate in moderate to severe oral lichen planus

Chauhan

Handa

et al. 2017

Dermatologic Therapy

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Topical corticosteroids are considered to be the most effective treatment for oral lichen planus (OLP). Methotrexate has been found to be effective in extensive cutaneous lichen planus. The objectives of the study were to evaluate the clinical efficacy and safety of topical triamcinolone 0.1% oral paste, oral methotrexate and a combination of these in symptomatic moderate-to- severe OLP. Forty-five patients were recruited and were allocated to three treatment arms with 15 patients in each treatment arm. They were treated for a period of 16 weeks or until complete clinical remission, whichever was earlier. The parameters assessed were clinical severity score, visual analogue score, and quality of life impairment questionnaire score. Forty-three patients completed the study. All three treatment modalities were effective. The patients in the combination group had significantly better reduction in the outcome parameters assessed compared to the other two groups. Nine patients achieved complete clinical remission, 6 in the combination group and 3 in the topical triamcinolone group. Systemic methotrexate, alone or in combination with topical triamcinolone, is effective in management of moderate to severe OLP.

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“…He concluded on the basis of clinical and laboratory parameters that methotrexate group A showed relatively less adverse effects than betamethasone group B. Thus, methotrexate can be used as an alternative safe drug therapy for the treatment of lichen planus 25 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of low dose oral Methotrexate vs Systemic Corticosteroids for treatment of Oral Lichen Planus

Saeed¹,

Firdous²,

Malik³

et al. 2021

PJMHS

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Background: Oral Lichen Planus (OLP) is a relatively common chronic inflammatory mucocutaneous disorder. WHO considers OLP a premalignant lesion. This makes management of OLP important to avoid its malignant transformation. Corticosteroids are considered as the first-line of treatment. Different other treatment modalities are also in use for OLP. But there is no statistically significant data available for a particular therapy. The recent evidences suggest methotrexate may effectively be used in low dose in the treatment of OLP. Aim: To compare the frequency of complete resolution of mucosal lesions of oral lichen planus with low dose oral methotrexate versus systemic corticosteroids. Methods: It was a randomized control trial conducted at Oral & Maxillofacial Surgery Department, King Edward Medical University/Mayo Hospital Lahore in six months. A sample of 60 patients was divided into two sub groups namely Group -A (methotrexate) and Group - B (corticosteroid) using lottery method. More than 75% resolution of mucosal lesions clinically was considered as complete resolution at the end of 8th week. Results: The mean age of the patients was 44.55±12.38 years. On 8th week, frequency of complete resolution of mucosal lesions was 73.3% in Group A and 60% in Group B with an insignificant difference (p-value<0.05). Conclusion: Methotrexate group A showed more complete resolution of mucosal lesions than corticosteroid group B with insignificant statistical difference. Keywords: Oral Lichen Planus, Mucosal lesions, Malignant transformation, Methotrexate, Corticosteroids

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Adverse outcome of methotrexate and mini pulse betamethasone in the treatment of lichen planus

Cited by 12 publications

References 14 publications

Lichen planus: a comprehensive evidence‐based analysis of medical treatment

Lichen planus: a comprehensive evidence‐based analysis of medical treatment

A prospective observational study to compare efficacy of topical triamcinolone acetonide 0.1% oral paste, oral methotrexate, and a combination of topical triamcinolone acetonide 0.1% and oral methotrexate in moderate to severe oral lichen planus

Comparison of low dose oral Methotrexate vs Systemic Corticosteroids for treatment of Oral Lichen Planus

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