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

Abstract

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.

Therapeutic strategies for oral lichen planus: State of the art and new insights

“…Oral CS, such as dexamethasone or prednisone, are commonly prescribed in case of recalcitrant OLP. Usually, oral prednisone (0.5 mg/Kg) for 4–6 weeks is used ( 46 ). The side effects of prolonged oral CS therapy can be severe and include muscle weakness, sleep disorders, weight gain, pathologic fractures, anemia, acne, striae rubrae, and menstrual abnormalities ( 47 ).…”

Unilateral lichen planus with Blaschko line distribution: A case report

“…However, in a study, LP patients rated their disease on the Dermatology Life Quality Index as equivalent to that of psoriasis. The resulting decrease in the quality of life places increased emphasis on the need for effective, lasting treatments for LP[ 16 ]. The first-line treatment for cutaneous LP includes topical steroids, intralesional injection of triamcinolone acetonide, systemic corticosteroid therapy (oral or intramuscular injection), oral acitretin or isotretinoin[ 10 , 17 ].…”

Effectiveness and tolerability of systemic therapies in oral lichen planus: A retrospective cohort study

“…However, these medications exhibit variable efficacy and potential adverse effects (AEs). 1 , 2 , 3 , 4 , 5 This study aimed to assess the efficacy and tolerability of systemic steroid-sparing therapies in OLP patients that had failed topical treatment.…”