Lichen planus – ein Klinikleitfaden

Abstract

Zusammenfassung Lichen planus (LP) ist eine chronisch lichenoide Erkrankung der Haut, der Schleimhäute und der Adnexe. Klassischerweise ist LP durch ein dichtes bandförmiges Infiltrat von T‐Zellen im oberen Teil der Dermis gekennzeichnet. Bisher wurden verschiedene Subtypen der Erkrankung beschrieben. Obwohl LP klinisch gut definiert ist, stellt die Erkrankung immer noch eine therapeutische Herausforderung dar. Insbesondere für LP‐Typen an Schleimhaut oder Kopfhaut, die oft rezidivieren und nicht auf Behandlungen ansprechenden, fehlen nach wie vor wirksame Therapien. LP bedingt eine sehr hohe psychosoziale Belastung bei den Betroffenen. Neue Erkenntnisse zur LP‐Pathogenese zeigen mögliche Angriffspunkte für Medikamente auf und ebnen so den Weg für künftige Therapien. In diesem klinischen Leitfaden fassen wir das aktuelle Wissen und die Therapiestandards zusammen und diskutieren die Zukunftsperspektive der Behandlung des LP.

Significant efficacy of short-course, low-concentration betamethasone mouthwash therapy for severe erosive oral lichen planus: a randomized controlled trial

“…Lichen planus is a common chronic inflammatory mucocutaneous disease with unclear etiology. The lesions often involve only the oral mucosa (oral lichen planus, OLP), characterized by multisite or bilateral symmetrical white reticular lesions sometimes accompanied by atrophic, bullous, or erosive lesions [ 1 , 2 ]. The global incidence of OLP is approximately 1.01%, and erosive oral lichen planus (EOLP) accounts for 32.46% of cases [ 3 ].…”

“…Unlike self-limited cutaneous lesions, oral erosions are difficult to self-heal and susceptible to recurrence, frequently causing painful symptoms in patients. [ 1 , 2 ] The World Health Organization (WHO) has considered OLP to be an oral potentially malignant disorder since 2007 [ 4 ]. As a potential risk factor in oral carcinogenesis, 1.05–2.85% of erosions may transform into malignant tumors, imposing a heavy psychological burden on patients with EOLP [ 5 ].…”

“…According to recent European S1 guidelines, OLP treatment options comprise first-line, second-line, and third-line treatments [ 2 ]. Topical steroids are the preferred drugs against localized erosions, such as clobetasol, fluocinonide, triamcinolone, dexamethasone, and betamethasone [ 6 ], while for widespread or multisite erosions of severe EOLP, the most effective medicines are oral corticosteroids [ 1 , 2 , 7 ]. For severe EOLP patients with contraindications or recalcitrant erosions to oral prednisone or methylprednisolone, the remaining first-line treatments, cyclosporine [ 8 , 9 ] and retinoids [ 10 , 11 ], and some second-line systematic treatments, such as azathioprine [ 12 ], methotrexate [ 13 ] and mycophenolate mofetil [ 14 , 15 ], can be considered.…”

“…For severe EOLP patients with contraindications or recalcitrant erosions to oral prednisone or methylprednisolone, the remaining first-line treatments, cyclosporine [ 8 , 9 ] and retinoids [ 10 , 11 ], and some second-line systematic treatments, such as azathioprine [ 12 ], methotrexate [ 13 ] and mycophenolate mofetil [ 14 , 15 ], can be considered. However, the efficacy of most systemic therapies has not been validated by randomized controlled trials (RCTs), and long-term use could cause a spectrum of side effects, such as hepatotoxicity, nephrotoxicity, myelotoxicity and increased risk of infection or malignant transformation [ 1 , 7 , 9 , 12 , 13 , 15 ]. Among the first-line treatments, topical steroids have been investigated in several prospective studies for treating severe EOLP patients, 42.9 to 93.3% of whom had a good response in decreasing clinical scores and 64.3 to 93.7% of whom had pain relief [ 16 – 21 ].…”