Systematic review of current systemic treatment options for erosive lichen planus

Ho, Joyce K; Hantash, Basil M.

doi:10.1586/edm.12.20

Cited by 10 publications

(3 citation statements)

References 61 publications

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“…Immunosuppressives such as cyclosporine, methotrexate and biologic agents have all been reported in EGLP. High recurrence rates are seen after cyclosporine withdrawal, while methotrexate has been proven in several case series, including a study that demonstrated marked improvement in genital and oral LP symptoms in a patient who had previously been managed with acitretin for 5 years. Adalimumab and etanercept have been used for EGLP with reported benefit, but have not been evaluated in EPLP.…”

Section: Discussionmentioning

confidence: 99%

Acitretin in erosive penile lichen planus

2016

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Lichen planus (LP) is an incompletely understood T-cell mediated auto-immune dermatosis. When LP involves the genitalia it may present as painful, pruritic erosions that can be exquisitely tender, causing distress and genitourinary and sexual dysfunction. Management of erosive genital LP is often suboptimal. Despite higher order evidence demonstrating the efficacy of oral acitretin in the management of cutaneous and oral LP, it still features below other immunosuppressive and immunomodulatory therapies in many clinicians' therapeutic ladder. We present a case of severe erosive penile LP, successfully treated with oral acitretin after topical and oral corticosteroids failed to induce remission.

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Section: Discussionmentioning

confidence: 99%

Acitretin in erosive penile lichen planus

2016

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“…Some patients benefit from the addition of topical tacrolimus [11]. Second-line treatments include systemic immunosuppressant or immune-modifying agents such as prednisolone, retinoids, methotrexate, cyclophosphamide, azathioprine, calcineurin inhibitors and mycophenolate mofetil [10,12,13]. The use of biologic drugs, including tumour necrosis factor (TNF) inhibitors, has been reported in case reports and case series with inconclusive results.…”

Section: Limited Treatment Optionsmentioning

confidence: 99%

“…Treatment options for GELP are limited, treatment results are poor, and scientific evidence of treatment efficacy and safety is scarce [ 2 , 3 , 9 , 10 ]. Based on clinical experience, the first-line treatment for GELP is the topical application of high-potency corticosteroids, such as clobetasol propionate 0.05%, which usually needs to be used throughout life.…”

Section: Introductionmentioning

confidence: 99%

Apremilast for genital erosive lichen planus in women (the AP-GELP Study): study protocol for a randomised placebo-controlled clinical trial

Skullerud

Gjersvik

Pripp

et al. 2021

Trials

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Background Genital erosive lichen planus (GELP) is a genital subtype of lichen planus, a chronic autoimmune inflammatory disease of unknown aetiology. In women, GELP is characterised by painful vulvo-vaginal mucosal erosions and scarring, often resulting in poor sexual health and reduced quality of life. Treatment options are limited and often with little effect. Apremilast, a phosphodiesterase 4-inhibitor, has been shown to have a positive effect on psoriasis and other inflammatory skin diseases. We aim to investigate the effect and safety of peroral apremilast in women with GELP in a randomised placebo-controlled double-blinded clinical trial. Methods We will recruit 42 adult women with characteristic clinical and/or histological features of moderate-to-severe GELP from a specialised vulva clinic in Oslo, Norway. The patients will be randomised 1:1 to either apremilast 30 mg BID (with an initial dose titration on days 1–6) or a placebo for 24 weeks. The concomitant use of topical corticosteroids will be allowed. The primary end point will be the mean GELP score, a clinical scoring system, at week 24 in the apremilast-treated patients versus the placebo-treated patients. The secondary end points will include the mean GELP score improvement from weeks 0 to 24, patient-reported use of topical steroids, the pain score on a visual analogue scale and the number of patients with GELP score improvements at weeks 16 and 24. The Physician Global Assessment , Patient Global Assessment and selected quality of life and sexual function assessments will be recorded at weeks 0, 16 and 24. The exploratory endpoints include description of immunohistochemical changes before and after apremilast therapy, assessed in vulvar or vaginal biopsies at weeks 0 and 24. Regular follow-ups for possible adverse events will be conducted. Discussion The study design is based on experience from studies on apremilast in other inflammatory skin diseases using equivalent apremilast doses for approved indications. The trial may provide evidence for the use of apremilast in women with this burdensome genital dermatosis. Trial registration ClinicalTrials.govNCT0365666. Registered on 4 September 2018.

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Dermatoses of the Oral Cavity and Lips

Carey,

Setterfield

2024

Rook's Textbook of Dermatology

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Systematic review of current systemic treatment options for erosive lichen planus

Cited by 10 publications

References 61 publications

Acitretin in erosive penile lichen planus

Acitretin in erosive penile lichen planus

Apremilast for genital erosive lichen planus in women (the AP-GELP Study): study protocol for a randomised placebo-controlled clinical trial

Dermatoses of the Oral Cavity and Lips

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