Treatment of cutaneous lichen planus (Part 1): A review of topical therapies and phototherapy

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

doi:10.1080/2331205x.2019.1582467

Cited by 10 publications

(15 citation statements)

References 56 publications

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“…Based on the lower rate of side effects and its greater ease of use, NB-UVB should be considered as the first-line phototherapeutic modality for this indication. Our findings concur with a recent review from Thandar et al, 41 which documented that NB-UVB is a suitable treatment option for cutaneous lichen planus and should be considered prior to systemic treatments. In non-responding patients or in case of unavailability of NB-UVB, oral or bath PUVA may serve as a valid alternative therapeutic measure.…”

Section: Treatment Outcome and Adverse Effectssupporting

confidence: 93%

Effectiveness of narrowband UVB phototherapy and psoralen plus UVA photochemotherapy in the treatment of generalized lichen planus: Results from a large retrospective analysis and an update of the literature

Weber

Marquart

Radaković

et al. 2021

Photoderm Photoimm Photomed

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Lichen planus (LP) is a chronic skin disease characterized by pruritic polygonal, purple, planar, and papular skin lesions that on the surface often show white lines known as "Wickham striae". 1 Also, the scalp, mucous membranes, or nails may be affected rendering LP a skin disorder with a broad spectrum of clinical presentations. [2][3][4] The exact prevalence of cutaneous LP in the general population is unknown but estimated to be 0.5%-1%. 3 While middle-aged men and women are equally affected by LP, incidence rates in children

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Section: Treatment Outcome and Adverse Effectssupporting

confidence: 93%

Effectiveness of narrowband UVB phototherapy and psoralen plus UVA photochemotherapy in the treatment of generalized lichen planus: Results from a large retrospective analysis and an update of the literature

Weber

Marquart

Radaković

et al. 2021

Photoderm Photoimm Photomed

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“…Medium to high potency topical corticosteroids were the most widely used treatment for cutaneous LP among children, consistent with what was previously published. 30 The favorable safety profile, efficacy, and convenient route of administration make the topical corticosteroids ideal to treat children with localized lesions. However, the most common previously used treatment was topical corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Pediatric lichen planus: a systematic review of 985 published cases

et al. 2021

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Background Lichen planus (LP) is a chronic inflammatory disorder usually occurring in middle-aged adults. Data are scarce in the pediatric population.Objective To describe the patients' characteristics, clinical presentation, and management of pediatric LP.Methods A systematic literature review of pediatric LP was performed in the Medline and Cochrane databases up to February 1, 2020. Demographic and clinical data were extracted for analysis, in addition to laboratory and histology findings, treatments used, and response to treatment. LP pemphigoides (LPP) was further pooled for a subcategory analysis.Results One hundred and sixty-four articles were included representing 985 patients. The most common country of origin was India. The most common clinical signs were flattopped papules (51%); the linear variant was present in 9%. Oral involvement was present in 22%. The most commonly used treatment was topical corticosteroids followed by systemic corticosteroids. The mean duration of treatment was 124.4 days. LPP patients had a short disease duration before diagnosis (4.1 months, P < 0.001) and failed previous treatment more frequently (P < 0.001). Systemic corticosteroids were more often prescribed in this subgroup (75%, P < 0.001) with more recurrence after treatment (31%, P = 0.048).Limitations Lack of randomized controlled studies, in addition to publication bias. ConclusionIn children, LP had a wide polymorphous clinical presentation, and the reported cases were mostly from India. The linear variant was more common and the oral mucosa was less affected in children. LPP, a rare subtype in children, was treated with systemic corticosteroids and recurred more frequently.

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“…8,11,12 Intralesional corticosteroids are also frequently utilized for LP, but multiple reviews consider the evidence to be poor and largely anecdotal. 10,11 Other non-systemic and topical treatments reported to be effective for LP include narrowband ultraviolet B radiation, psoralen plus ultraviolet A radiation, topical calcineurin inhibitors, topical cyclosporin, and vitamin D3 analogues. 7,8,11,12 For many clinicians, failure to improve with local treatments or those with severe or widespread disease warrants the initiation of systemic medications.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, several literature reviews highlight the lack of evidence in randomized clinical trials of their efficacy in treating LP, attributing the wide‐spread use of topical corticosteroids to physician experience and confidence rather than clinical data 8,11,12 . Intralesional corticosteroids are also frequently utilized for LP, but multiple reviews consider the evidence to be poor and largely anecdotal 10,11 . Other non‐systemic and topical treatments reported to be effective for LP include narrow‐band ultraviolet B radiation, psoralen plus ultraviolet A radiation, topical calcineurin inhibitors, topical cyclosporin, and vitamin D3 analogues 7,8,11,12 …”

Section: Discussionmentioning

confidence: 99%

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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Treatment of cutaneous lichen planus (Part 1): A review of topical therapies and phototherapy

Cited by 10 publications

References 56 publications

Effectiveness of narrowband UVB phototherapy and psoralen plus UVA photochemotherapy in the treatment of generalized lichen planus: Results from a large retrospective analysis and an update of the literature

Effectiveness of narrowband UVB phototherapy and psoralen plus UVA photochemotherapy in the treatment of generalized lichen planus: Results from a large retrospective analysis and an update of the literature

Pediatric lichen planus: a systematic review of 985 published cases

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

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