Oral, Esophageal and Cutaneous Lichen Ruber Planus Controlled with Alitretinoin: Case Report and Review of the Literature

Abstract

Background: Therapy-resistant lichen planus (LP) can be a challenging condition for dermatologists. There are some case reports about successful treatments with alitretinoin of cutaneous and oral, but not of esophageal LP. Objective: We present the unique case of a patient with cutaneous, oral and esophageal LP which was refractory to classical treatment options (topical clobetasol propionate and pimecrolimus, intramuscular triamcinolone acetonide); because of systemic side effects the patient did not tolerate systemic acitretin dosed up to 25 mg daily. Methods: Oral alitretinoin was used at a dose of 30 mg daily. Results: Both oral and skin changes as well as dysphagia completely resolved within 4 weeks without any severe side effects and the drug was used for 6 months. No papules, intraoral striae or dysphagia recurred during the 6 months of treatment. After 4 months the patient relapsed with mucosal patches so that a second cycle was initiated for 6 months where oral LP lesions resolved after 4 weeks also (with sporadic mild headache). Conclusion: Further studies are needed to better understand the impact of alitretinoin in LP. Our observation suggests alitretinoin as a new, well-tolerated treatment option for esophageal LP after failed response to conventional treatments.

Successful Treatment of Recalcitrant Prurigo with Alitretinoin

“…In addition to its approved use, alitretinoin has been reported to be beneficial also in refractory pityriasis rubra pilaris [6] , lichen planus [7,8] , cutaneous lupus erythematosus [9] , palmoplantar pustular psoriasis [10] as well as in mycosis fungoides [11] , but it appeared to have a mixed effect in congenital ichthyosis [12] . Several studies have also been carried out with alitretinoin used in the treatment of AIDS-related Kaposi's sarcoma [13] .…”

Successful Treatment of Nail Lichen Planus with Alitretinoin: Report of 2 Cases and Review of the Literature

“…The benefit of systemic retinoids for LP is supposed to result from their antiproliferative mode of action mediated by binding to nuclear receptors (RAR and RXR) and there is some evidence of receptor expression in the nail matrix [4]. The positive effect of alitre- tinoin on skin, oral, esophageal and nail LP has already been described [5]. In our 2 cases, the patients showed nail LP which was refractory to classic treatment options (topical corticosteroid and tacrolimus ointment 0.1%).…”

“…We report 2 cases of nail LP that were successfully treated with alitretinoin. Using PubMed, a review of the English literature revealed one case report of nail LP treated with alitretinoin [4] and another case of oral, esophageal and cutaneous LP controlled with alitretinoin that also showed nail improvement [5]. Our objective is to report additional cases to the scant existing literature to learn more about therapeutic options for nail LP.…”

Lichen Planus

“…In one anecdotal report, a patient was treated with 30 mg/day with good results within 4 weeks. No severe side effects were registered, but oral striae and dysphagia recurred during treatment and LP relapsed after 4 months (Kolios et al 2013 ).…”

“…Recently, some reports of recalcitrant lichen planus successfully treated with alitretinoin have been published (Kolios et al 2013 ;Brehmer et al 2011 ).…”