Pulsed High-Dose Corticosteroids Combined With Low-Dose Methotrexate Treatment in Patients With Refractory Generalized Extragenital Lichen Sclerosus

Abstract

Background: Lichen sclerosus (LS) is a rare, chronic inflammatory skin disease that predominantly affects the anogenital area. A few patients exhibit widespread extragenital disease that may lead to blister formation and superficial erosions. We evaluated the efficacy of pulsed high-dose corticosteroids combined with low-dose methotrexate treatment in patients with refractory generalized LS that had failed to respond to standard topical corticosteroid therapy.

Lichen sclerosus of the oral cavity. Case report and review of literature.

“…10 Literature shows successful treatment of refractory generalized extragenital lichen sclerosus with pulsed high-dose corticosteroids combined with methotrexate. 26 Histopathological confirmation of oral LS is necessary to rule out other whitish lesions such as lichen planus and localized scleroderma which require different management.…”

Hypopigmented papules on the upper trunk and forearm of a young man

“…Other reported treatments include topical retinoids, topical tacrolimus or pimecrolimus, oral steroids, cyclosporine, phototherapy, laser therapy, and surgical excision 6–8 . Patients with severe and refractory disease may be treated with high‐dose corticosteroids combined with low‐dose methotrexate therapy 9 …”

Vulvar Dermatoses

“…Ancak bunlarında teorik olarak malignensi potansiyelleri bulunduğu için komplike olmayan olgularda kullanılmaması tavsiye edilmektedir (35,46,47). Şiddetli ve tedaviye cevap vermeyen LS olgularında literatür verileri sınırlı olmakla birlikte sistemik metotreksat, asitretin ve metotreksatla birlikte puls metilprednizolon tedavisi uygulanabilir (48,49). Tedaviden sonra nüks eden olgularda sekonder enfeksiyonlar, kontakt dermatitler ve malignensiler mutlaka ekarte edilmelidir (35).…”