Yasmeen Thandar1, Rivesh Maharajh1, Firoza Haffejee1, Anisa Mosam2. 1. a Faculty of Heath Sciences, Department of Basic Medical Sciences, Durban University of Technology , Durban , South Africa. 2. b Department of Dermatology, University of KwaZulu-Natal and Nelson Mandela School of Medicine , Durban , South Africa.
Abstract
Background: Although numerous medications are available for the treatment of cutaneous lichen planus (CLP), recurrence is common and there is a lack of evidence of efficacy of many treatment options. Part 1 reviewed consolidated evidence from topical therapies and phototherapy. In Part 2, all systemic treatments are assessed. Methods: All English studies, regardless of design, investigating the outcome of systemic treatment for CLP, until January 2018, were included. While there were only a few well-designed randomized control trials (RCTs), evidence was extrapolated and graded from open trials, case series as well as case reports. Results: Mini pulse therapy with corticosteroids should be considered over moderate daily dosing with retinoids being an alternative option. Low-dose methotrexate is considered effective and safe provided it is regularly monitored. Azathioprine, cyclosporine and mycophenolate mofetil require larger more defined RCTs in resistant CLP. Low-molecular-weight heparins may be considered in patients with no response to first-line treatment. Biologics are potentially promising but there is a need for RCTs with a considerable duration to determine their long-term safety profiles. Evidence with various other drugs were reported. Conclusion: Clinicians may have a broader perspective on the efficacy of treatments across all study profiles.
Background: Although numerous medications are available for the treatment of cutaneous lichen planus (CLP), recurrence is common and there is a lack of evidence of efficacy of many treatment options. Part 1 reviewed consolidated evidence from topical therapies and phototherapy. In Part 2, all systemic treatments are assessed. Methods: All English studies, regardless of design, investigating the outcome of systemic treatment for CLP, until January 2018, were included. While there were only a few well-designed randomized control trials (RCTs), evidence was extrapolated and graded from open trials, case series as well as case reports. Results: Mini pulse therapy with corticosteroids should be considered over moderate daily dosing with retinoids being an alternative option. Low-dose methotrexate is considered effective and safe provided it is regularly monitored. Azathioprine, cyclosporine and mycophenolate mofetil require larger more defined RCTs in resistant CLP. Low-molecular-weight heparins may be considered in patients with no response to first-line treatment. Biologics are potentially promising but there is a need for RCTs with a considerable duration to determine their long-term safety profiles. Evidence with various other drugs were reported. Conclusion: Clinicians may have a broader perspective on the efficacy of treatments across all study profiles.
Authors: Majid Moshirfar; Harry Y Liu; David B Rosen; Madeline B Heiland; Masoud Mirghorbani; Yasmyne C Ronquillo; Phillip C Hoopes Journal: Med Hypothesis Discov Innov Ophthalmol Date: 2019
Authors: Eva Schruf; Mona Hc Biermann; Josephine Jacob; Dennis Häckl; Maximilian Reinhardt; Michael Hertl; Johannes Wohlrab Journal: J Dtsch Dermatol Ges Date: 2022-08-01 Impact factor: 5.231