Induction of Dramatic Hyperpigmentation in a Patient with Generalized Lichen Planus Treated with Re-PUVA

Carlin, Christopher S.; Florell, Scott R.; Krueger, Gerald G.

doi:10.1177/120347540200600206

Cited by 7 publications

(7 citation statements)

References 14 publications

(1 reference statement)

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“…A secondary hyperpigmentation has been reported after use of Re‐PUVA (retinoids plus PUVA) in a case of generalized LP . However, since the reaction started after the third dose of PUVA, it is not clear whether this report illustrates a case of photosensitization secondary to isotretinoin alone or in combination with PUVA.…”

Section: Phototherapymentioning

confidence: 84%

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: Phototherapymentioning

confidence: 84%

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

Husein‐ElAhmed

Gieler

Steinhoff

2019

Acad Dermatol Venereol

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“…[228][229][230][231] Hyperpigmentation is usually a result of repeated PUVA treatments but may occur with the concurrent use of topical vitamin D analogues at treated lesional sites, 232,233 and with concomitant treatment with isotretinoin. 234 Triggering of herpes simplex virus can occur with PUVA and use of high-factor sunscreen on the lips and prophylactic aciclovir for susceptible subjects is recommended. Eczema herpeticum has been reported in a patient with AD treated with PUVA.…”

Section: Incidence Of Acute Adverse Eventsmentioning

confidence: 99%

“…233 Transient hyperpigmentation has also been reported around psoriatic plaques in patients treated with calcipotriol ointment and PUVA. 234 Acquired dermal melanocytosis typically affecting the back of Japanese patients treated with PUVA has been reported. 326,327 PUVA can result in dose-related premature ageing of the skin, manifesting as wrinkling, xerosis, loss of elasticity, freckling, telangiectasia, mottled pigmentation, yellowing of the skin and comedones.…”

Section: Psoralen-ultraviolet a Therapy-induced Skin Cancermentioning

confidence: 99%

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British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen–ultraviolet A therapy 2015

et al. 2016

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“…Level of evidence The combination of PUVA and retinoids (re-PUVA) may help improving efficacy and limiting side effects in severe cases [11]; however a relatively high risk for disproportionate hyperpigmentation limits this modality especially in darker skin [12]. In our experience a combination of narrowband UVB and retinoids may be an alternative to re-PUVA with comparable efficacy and a lower risk for hyperpigmentation.…”

Section: Basic Therapy (Combination With Every Other Modality Possible)mentioning

confidence: 96%

Individualizing treatment and choice of medication in lichen planus: a step by step approach

Manousaridis

Peitsch

et al. 2013

J Deutsche Derma Gesell

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SummaryAlthough lichen planus is one of the most common dermatological entities, very few reviews on its management exist in the literature. Standard therapeutic approaches include various topical treatments (including topical corticosteroids, calcineurin inhibitors, vitamin D analogs) and phototherapy modalities, as well as systemic corticosteroids and systemic retinoids. While localized skin lesions are easily managed with standard modalities, generalized forms and in particular involvement of hair follicles, nails and mucosa, as well as eyes are often challenging. This review proposes an evidence-based and differential therapeutic regime, taking into account many new emerging systemic therapies to help clinicians optimize treatment according to the type, extent and severity of the disease. An individual therapeutic ladder has been developed for each location, starting with standard modalities and ranking alternative systemic treatments (mainly methotrexate and hydroxychloroquine, as well as cyclosporine, azathioprine and mycophenolate mofetil) according to efficacy, evidence level and side-effect profile.

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Induction of Dramatic Hyperpigmentation in a Patient with Generalized Lichen Planus Treated with Re-PUVA

Abstract: As the hyperpigmentary reaction did not occur until the third PUVA dose, which was near the steady state of isotretinoin, this case may illustrate a case of photosensitization secondary to isotretinoin alone or isotretinoin in combination.

Cited by 7 publications

References 14 publications

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

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

British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen–ultraviolet A therapy 2015

Individualizing treatment and choice of medication in lichen planus: a step by step approach

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