The use of hydroxychloroquine as a systemic treatment in erosive lichen planus of the vulva and vagina

2021 European guideline for the management of vulval conditions

“…Of the limited evidence available, the most favourable in terms of efficacy appears to be for hydroxychloroquine, methotrexate (MTX) and mycophenolate mofetil given in standard doses. A recent retrospective study 108 reported that 9 of 15 patients (60%) responded to hydroxychloroquine, with almost half experiencing long‐term effect. Another study 109 reported significant improvement in 19 of 27 patients (70%) with erosive LP treated with long‐term MTX however other studies 91,110 reported poorer results. Mycophenolate mofetil 111,112 and cyclosporin 113 may also be effective and worth considering for selected cases. Oral steroids, for example prednisolone 40 mg/day, tapered off over a few weeks, may be used for severe flares; courses can be repeated as necessary. …”

Vulvovaginal erosive lichen planus refractory to topical therapies: What's next? A case report

“…Evidence for hydroxychloroquine effectiveness in LP has been found in small case series. [ 6 , 18 ] No appreciable response to hydroxychloroquine was observed in this case at 3 months, hence, mycophenolate, a drug with an established record in treatment of cutaneous inflammatory diseases, was substituted. Mycophenolate has been used successfully in small case series of LP.…”

Commentary: Systemic Therapy for Mucosal Lichen Planus with a Focus on Oral Lichen Planus: Update and Review of Challenges and Successes

“…Of these, hydroxychloroquine would be the first choice. Several trials with 10 patients 22 , 21 patients 23 , and a retrospective review 24 support the use of hydroxychloroquine in MLP. A trial of 3-6 months should be undertaken.…”