Mycophenolate mofetil versus methotrexate for vulvar lichen planus: A 10-year retrospective cohort study demonstrates comparable efficacy and tolerability

Hrin, Matthew L.; Bowers, Nathan L.; Feldman, Steven R.; Huang, William W.; Pichardo, Rita O

doi:10.1016/j.jaad.2021.08.061

Cited by 10 publications

(6 citation statements)

References 4 publications

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“…As age increased, the odds of requiring systemic treatment for VLP decreased with an OR of 0.96 (95% CI 0.94–0.99, p = 0.002), corresponding to a 4% reduction in odds of requiring systemic treatment as the ‘age at diagnosis’ of VLP increased by 1 year. The mean age of patients who required systemic treatment (48.6 years) in our cohort is lower than that of other studies reporting systemic treatment of VLP; Hrin and colleagues reported a mean age of 59 and 63 years for patients with VLP treated with mycophenolate mofetil and methotrexate, respectively 11 . The mean age of Fahy and colleagues 100‐patient VLP cohort was 60.3 years, although the mean age of the 43 patients requiring systemic treatment was not quoted 7 …”

Section: Discussioncontrasting

confidence: 68%

“…The mean age of patients who required systemic treatment (48.6 years) in our cohort is lower than that of other studies reporting systemic treatment of VLP; Hrin and colleagues reported a mean age of 59 and 63 years for patients with VLP treated with mycophenolate mofetil and methotrexate, respectively. 11 The mean age of Fahy and colleagues 100-patient VLP cohort was 60.3 years, although the mean age of the 43 patients requiring systemic treatment was not quoted. 7 Women who are younger with VLP may be less accepting of dyspareunia at a critical time where uncontrolled vulvovaginitis can impact fertility; this group may have a higher threshold for acceptable disease control and be more inclined to accept the risks of systemic treatment.…”

Section: Discussionmentioning

confidence: 99%

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Identifying predictors of systemic immunosuppressive treatment of vulvovaginal lichen planus: A retrospective cohort study of 122 women

Kherlopian

Fischer

2022

Aust J Dermatology

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Background Between 20% and 40% of women with vulvovaginal lichen planus (VLP) fail to respond to first‐line ultra‐potent topical corticosteroid treatment and require systemic immunosuppression to control disease. No data exist regarding risk factors for patients with severe VLP requiring systemic immunosuppression. We aimed to identify clinical features that predict women with VLP who are at risk of severe, recalcitrant disease requiring eventual escalation to systemic treatment. Methods A chart review was performed on a cohort of 122 adult women with VLP followed prospectively for 15 years by the same clinician in a private dermatology practice in Australia between 1 January 2004 and 1 October 2021. Uni‐ and multivariable binary logistical regression analyses were performed to identify clinical features distinguishing women eventually requiring systemic treatment of VLP against those whose VLP was controlled with topical corticosteroids alone. Results The mean age at diagnosis of VLP was 61 years, with 35 women (28.7%) requiring systemic treatment of VLP. A multivariable regression model utilising ‘Age at Diagnosis’ (adjusted OR = 0.97, 95% CI 0.94–0.99), ‘Non‐Caucasian Ethnicity’ (adjusted OR = 10.3, 95% CI 2.27–73.9) and ‘Vulvar Pruritus’ (adjusted OR = 2.69, 95% CI 1.11–6.86) demonstrated moderate predictive capacity, with specificity and sensitivity for predicting whether a patient will require systemic treatment for VLP of 95.3% and 40.5%, respectively. Conclusions Our findings may indicate women with VLP who are younger, of non‐Caucasian ethnicity, and presenting with vulval pruritus are the highest risk of severe disease requiring systemic immunosuppressive treatment and may benefit most from earlier initiation of systemic treatment.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Identifying predictors of systemic immunosuppressive treatment of vulvovaginal lichen planus: A retrospective cohort study of 122 women

Kherlopian

Fischer

2022

Aust J Dermatology

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“…19 Systemic immunosuppressions, such as prednisone, azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, adalimumab, and tildrakizumab, were reported to be more effective in combating VLP in combination with topical corticosteroids or tacrolimus. 4,5,6,9,[20][21][22] Other drugs, such as cyclosporine, were also used but with less success and more adverse effect on patients. 5,6 The efficacy of using oral prednisone alone and with topical corticosteroids to achieve initial control has been shown with eventual transition to topical tacrolimus to maintain remaining disease activity.…”

Section: Discussionmentioning

confidence: 99%

Vulvar lichen planus–induced vulvovaginal stenosis: A case report and review of the literature

Chow

Gill

Alzahrani

et al. 2023

SAGE Open Medical Case Reports

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The authors report a case of vulvar lichen planus–induced vulvovaginal stenosis along with a review of the current literature. The authors outline a case of a patient with biopsy-proven vulvar lichen planus who subsequently developed a vulvovaginal stenosis. Treatment was initiated with clobetasol ointment, oral prednisone, later transitioned to oral methotrexate and clobetasol, and then switched to acitretin. Collaboration with the patient’s family physician and the hypertension clinic has been sought to remove medications associated with lichenoid reactions from the patient’s regimen. Review of literature was conducted through Ovid MEDLINE. Only six cases of vulvar lichen planus–induced vulvovaginal stenosis had been found, suggesting the relative rarity of this severe disease presentation. The patient has achieved control with her current regimen, as well as some clinical improvement of the resulting vaginal stenosis. Vulvovaginal stenosis can be induced by vulvar lichen planus, and its management requires a multimodal and multidisciplinary approach.

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“…Second-line treatment options include calcineurin inhibitors like tacrolimus or even systemic immunosuppressants such as prednisolone, retinoids, methotrexate, cyclophosphamide, azathioprine, and mycophenolate mofetil [17 ▪ ]. Data for systemic treatment and robust clinical trials are indeed lacking and often only include small groups or case series [18].…”

Section: Lichen Planusmentioning

confidence: 99%

Complex vulvar and vaginal disease in menopause

Fuller

Dunsmoor-Su

2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewMenopause is a time of vulvar and vaginal changes that are physiologic and are often symptomatic. These changes can impact up to 50% of women in menopause. There are also several vulvar dermatoses that are more common after menopause and should be recognized early to allow for symptomatic treatment. Some of these conditions can lead to squamous cell carcinoma over time, and early recognition and appropriate treatment reduce this risk. Treatment for women with symptomatic vulvar and vaginal conditions is important for maintaining the quality of life. Recent findingsThere are multiple review articles, small case series, and small comparative trials, but definitive trials are unavailable for most of these conditions. SummaryCurrent research on pathophysiology and treatment is limited to all of these conditions, and more focus on these life-altering conditions is warranted.

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Mycophenolate mofetil versus methotrexate for vulvar lichen planus: A 10-year retrospective cohort study demonstrates comparable efficacy and tolerability

Cited by 10 publications

References 4 publications

Identifying predictors of systemic immunosuppressive treatment of vulvovaginal lichen planus: A retrospective cohort study of 122 women

Identifying predictors of systemic immunosuppressive treatment of vulvovaginal lichen planus: A retrospective cohort study of 122 women

Vulvar lichen planus–induced vulvovaginal stenosis: A case report and review of the literature

Complex vulvar and vaginal disease in menopause

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