Treatment of cutaneous lichen planus (part 2): a review of systemic therapies

Thandar, Yasmeen; Maharajh, Rivesh; Haffejee, Firoza; Mosam, Anisa

doi:10.1080/09546634.2018.1544411

Cited by 14 publications

(18 citation statements)

References 68 publications

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“…6 Several systemics have been reported in the literature with variable degrees of success, including oral retinoids, azathioprine, sulfasalazine, cyclosporine, mycophenolate mofetil, methotrexate, and low-molecular-weight heparins. 6,8,13 Oral glucocorticoids like prednisone are also commonly prescribed, with reported complete response rates varying from 13% to 59%. 12 The typical dosage of prednisone ranges from 30 to 60 mg/day for 4-6 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…8,10 Randomized studies revealed significantly improved outcomes with prednisone, however relapse rates and adverse effects were higher than other therapies. 8,13 The side effects of prolonged glucocorticoids can be severe, such as muscle weakness, sleep disturbances, weight gain, pathologic fractures, anemia, dyspepsia, acne, striae, and menstrual abnormalities. 12,14 Recently, oral mini-pulse therapy with 5 mg betamethasone has been proposed to minimize the side effects associated with oral corticosteroids, and was found to have an earlier response rate when compared to triamcinolone paste.…”

Section: Discussionmentioning

confidence: 99%

“…12,14 Recently, oral mini-pulse therapy with 5 mg betamethasone has been proposed to minimize the side effects associated with oral corticosteroids, and was found to have an earlier response rate when compared to triamcinolone paste. 6,13 Intramuscular corticosteroids have remained an enduring and promising therapy for many dermatologic diseases. Previous reports have shown success with IM TAC in atopic dermatitis, systemic lupus erythematous, and alopecia areata without the significant side effects associated with oral corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

“…For many clinicians, failure to improve with local treatments or those with severe or widespread disease warrants the initiation of systemic medications 6 . Several systemics have been reported in the literature with variable degrees of success, including oral retinoids, azathioprine, sulfasalazine, cyclosporine, mycophenolate mofetil, methotrexate, and low‐molecular‐weight heparins 6,8,13 . Oral glucocorticoids like prednisone are also commonly prescribed, with reported complete response rates varying from 13% to 59% 12 .…”

Section: Discussionmentioning

confidence: 99%

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Successful systemic treatment outcomes of lichen planus: A single‐center retrospective review

Hunt

Klager

Kwak³

et al. 2021

Dermatologic Therapy

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Lichen planus (LP) affects up to 4% of adults and can cause significant distress and morbidity, especially to those with persistent disease. As many as 20% of patients with LP may exhibit widespread or recalcitrant disease necessitating systemic treatment options. We sought to evaluate the effectiveness of systemic treatments for severe and recalcitrant LP not responsive to topical corticosteroids or calcineurin inhibitors. Over a 10‐year period, 374 patients with cutaneous and mucosal LP were evaluated at a major regional tertiary medical center; 94 qualified for inclusion in the study. In all, 26 (28%) patients achieved remission, 52 (55%) experienced stable disease control, and 16 (17%) failed all attempted treatments. Among medications most trialed, intramuscular triamcinolone (IM TAC), hydroxychloroquine, and methotrexate were most successful with 79%, 61%, and 42% respective response rates. In contrast, oral corticosteroids and dapsone were less frequently successful at rates of 24% and 20%. IM TAC represented the highest level of treatment success and was statistically significant compared to other systemic treatments (P < .01). Among adjuvant therapies, intralesional triamcinolone (IL TAC) demonstrated higher success (71%) than oral corticosteroids (29%). Based on this multi‐year evaluation, we recommend that clinicians consider IM TAC as a first‐line systemic option for severe or refractory LP, with hydroxychloroquine as the steroid‐sparing treatment of choice. For patients requiring adjuvant therapy, IL TAC should be considered to hasten response and symptom relief. Patients with severe or widespread disease may benefit from earlier initiation of systemic therapy to prevent significant morbidity and impact on daily function.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Successful systemic treatment outcomes of lichen planus: A single‐center retrospective review

Hunt

Klager

Kwak³

et al. 2021

Dermatologic Therapy

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“…The natural history of cutaneous LP is to remit within one to two years, while lesions affecting the scalp, genitals and nails may be more persistent [9]. Since this disorder is self-resolving, management is usually focused speeding up the process of resolution and treating pruritis.…”

Section: Discussionmentioning

confidence: 99%

Generalized hypertrophic lichen planus: an atypical presentation of a characteristic disease

Mirchandani

Ballal

Rodrigues

et al. 2020

Medicine and Pharmacy Reports

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Lichen planus is a common chronic inflammatory condition that affects skin and mucous membranes. Management is often delayed because of patient embarrassment or misdiagnosis by the clinician. Early recognition and treatment is essential to reduce the morbidity of this condition. We present a 58-year-old woman diagnosed with generalized hypertrophic lichen planus, a rare event, reported to occur usually on lower extremities, but found to be generalized in our patient, requiring excision of symptomatic lesions. We suggest a multidisciplinary approach to allay the anxiety and symptoms of these patients and to improve the quality of life and clinical outcomes.

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Lichen ruber

Abeck¹

2020

Häufige Hautkrankheiten in Der Allgemeinmedizin

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Treatment of cutaneous lichen planus (part 2): a review of systemic therapies

Cited by 14 publications

References 68 publications

Successful systemic treatment outcomes of lichen planus: A single‐center retrospective review

Successful systemic treatment outcomes of lichen planus: A single‐center retrospective review

Generalized hypertrophic lichen planus: an atypical presentation of a characteristic disease

Lichen ruber

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