Management Of Lichen Planus Research Articles

Lichen Planus: What is New in Diagnosis and Treatment?

Lichen planus (LP), an idiopathic, multifaceted chronic inflammatory disease with a heterogeneous clinical presentation, affects approximately 0.5-1% of the population. The various clinical manifestations of LP fall into three broad categories, namely cutaneous, appendageal, and mucosal, with further subclassification depending on the morphology and distribution patterns of individual lesions. There is mounting evidence that LP has systemic associations, including autoimmune conditions, glucose intolerance, dyslipidemia, and cardiovascular disorders. Cutaneous hypertrophic and mucosal forms of LP are at a heightened risk for malignant transformation. Familiarity with these potential associations in conjunction with long-term follow-up and regular screening could lead to a timely diagnosis and management of concomitant conditions. In addition, the frequent quality of life (QoL) impairment in LP underscores the need for a comprehensive approach including psychological evaluation and support. Several treatment strategies have been attempted, though most of them have not been adopted in clinical practice because of suboptimal benefit-to-risk ratios or lack of evidence. More recent studies toward pathogenesis-driven treatments have identified Janus kinase inhibitors such as tofacitinib, phosphodiesterase-4 inhibitors such as apremilast, and biologics targeting the interleukin-23/interleukin-17 pathway as novel therapeutic options, resulting in a dramatic change of the treatment landscape of LP. This contemporary review focuses on the diagnosis and management of LP, and places emphasis on more recently described targeted treatment options.

Management of Lichen Planus in a Post Liver Transplant Patient with Lupus Erythematosus, and Ulcerative Colitis; A Case Report

Background: Lichen planus (LP) is a chronic mucocutaneous inflammatory condition characterized by white striations and plaques or erythematous /erosive lesions in the oral cavity. LP has affected about 0.5 -1% of world population. Apart from the potential of autoimmune origin, the WHO classified oral LP (OLP) as a premalignant condition, with an increased risk of developing squamous cell carcinoma of the head and neck (SCCHN). Patients with LP have exhibited a higher susceptibility to other autoimmune diseases (about 25%). Case Presentation: A 51-year-old woman with a history of OLP and concurrent lupus erythematosus, transplanted Liver, and ulcerative colitis was referred to the Oral and Maxillofacial Medicine Department of Tehran Dental Faculty. A noteworthy point in this study, which was not commonly observed in previous reports, was the existence of OLP with three autoimmune diseases. The lichenoid oral ulcers of the patient were managed by modifying her drug regimen under consultation with a physician using systemic and topical corticosteroids, and, finally, cryotherapy. Conclusions: This case, not the first case of autoimmune diseases, illustrates the management of the challenges of an oral lesion accompanying other systemic diseases and highlights the importance of awareness of the oral manifestations of systemic diseases and their side effects. According to previous studies, the response of oral lesions to different treatments is unique, and the patient's lifestyle and his/her other systemic diseases influence the treatment success or failure. The patient's management protocol and its validity can be re-evaluated in future studies as clinical trial projects.

Evaluation of the Efficacy and Safety of Apremilast in the Management of Lichen Planus.

Lichen planus is a chronic disease with often disappointing and less than optimal treatment options. Apremilast modulates inflammatory signalling pathways which play a central role in the pathogenesis of lichen planus, thus making it useful in the management of such patients. The present study was an investigator-initiated, single-centre, non-randomized, open-label, pilot study of the efficacy and safety of Apremilast in the treatment of lichen planus. All the patients were prescribed Apremilast 30mg, twice daily, for 12 weeks. Patients were evaluated for improvement in their lesions, based on the physician's global assessment (PGA), subject global assessment (SGA), and target area lesion symptom score (TALSS). A total of 34 patients were included in the study; 26 patients completed the study duration and were considered for the final analysis. After 12 weeks, 34.61% (n = 9/26) patients showed 2 or more grade improvement in their disease as per PGA. About 42.30% (n = 11/26) patients achieved more than 50% improvement in their lesions based on the subject global assessment of their disease. There was a significant improvement in TALSS during the study period (p < 0.0001). Only 23.07% (n = 6/26) patients developed one or more adverse events because of Apremilast with headache being the commonest side effect. The results obtained in our study justify that Apremilast is efficacious and safe in the management of patients with lichen planus. Based on these results, Apremilast can be considered as a promising alternative treatment option in patients with lichen planus.

Updates in Causes, Risk Factors, Diagnosis and Management of Lichen Planus

Bhutani et al. originally described a pigmented variety of lichen planus (LP) from India in 1974, and created the label LP pigmentosus (LPP) to better describe it. LPP is one of several variations of the LP gene. This skin lesion has also been reported in the Middle East, Latin America, Korea, and Japan, and is more common in those with darker skin. The most common differential diagnosis for LPP is erythema dyschromicum perstans (EDP). Fixed drug eruption, macular amyloidosis, urticaria pigmentosa, tar melanosis, frictional melanosis, berloque dermatitis, pigmented beautifying dermatitis (Reihl's melanosis), and pigmented beautifying dermatitis (Reihl's melanosis) are some of the other differences. Cutaneous LP usually clears up on its own after 1 to 2 years, thus care focuses on lowering pruritus and speeding up the healing process. First-line management for limited LP is superpotent interesting steroids (clobetasol 0.05%) twice daily for 2 to 4 weeks.&#x0D; This study aims to:&#x0D; 1- Recognize the causes and risk factors for lichen planus&#x0D; 2- Correct diagnosis of lichen planus&#x0D; 3- Provide effective treatment for lichen planus

Oral lichen planus and its recent management: A review

Background: Oral Lichen Planus (OLP) is one of the most common dermatological disease which is present in the oral cavity. It is a chronic autoimmune, mucocutaneous disease that affects oral mucosa as well as the skin, genital mucosa and other sites of the body.Method: In this review study, various databases such as Google Scholar, PubMed Central, Hinari and Cochrane library were searched for articles with keywords lichen planus, oral lichen planus, premalignant lesions, management of Lichen planus. Articles were searched from January 2015 to 5th November 2020.Result: From the 34 articles obtained after reviewing the abstracts, most relevant 32articles were evaluated in this study.Conclusion: The etiology, pathophysiology, clinical presentation, histopathological features, diagnosis and various management for oral lichen planus is discussed. This article also compares the existing and the most recent treatment modalities that are available throughout the world that are discussed in the literatures. However, more intensive studies must be carried out to find the best treatments which are cost-effective in the long run.&#x0D; Update Dent. Coll. j: 2020; 10 (2): 29-34

Effect of personality traits on the oral health-related quality of life in patients with oral lichen planus undergoing treatment

ObjectivesThe aim of this study was to evaluate the relationship between personality traits and perceived treatment success in oral lichen planus.Material and methodsA total of 53 patients with diagnosed oral lichen planus were evaluated at the time of diagnosis and along the course of their treatment. The visual analogue scale (VAS) was used for evaluating pain and burning sensation, along with an evaluation of the oral health-related quality of life (OHIP) and the clinical severity. In order to determine the personality trait, the NEO-FFI questionnaire was applied. Data were assessed with the statistical software Stata by a multiple linear regression.ResultsA significant relationship between the two personality traits: “conscientiousness” and “extraversion” and a perceived improvement in oral lichen planus could be observed. The higher the “conscientiousness,” the better the perceived oral health-related quality of life. Furthermore, “extraversion” had a significant influence on the improvement in clinical severity index (P < 0.05).ConclusionsPersonality traits, especially conscientiousness and extraversion, have a significant impact on the perception of therapeutic intervention in oral lichen planus.Clinical relevanceAs personalized patient management is gaining importance and psychosocial factors play a significant role in mucosal diseases, the patient’s psychological profile should be considered in the oral lichen planus management.

Effectiveness of oral colchicine in the management of lichen planus

Effectiveness of oral colchicine in the management of lichen planus

European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology

Lichen planus (LP) is a chronic inflammatory and immune-mediated disease that affects the skin, hair, nails and mucous membranes. Although there is a broad clinical spectrum of lichen planus manifestations, the skin and oral cavity remain the major sites of involvement. A group of European dermatologists with a long-standing interest and expertise in lichen planus has sought to define therapeutic guidelines for the management of patients with LP. The clinical features, diagnosis and possible medications that clinicians can use, in order to control the disease, will be reviewed in this manuscript. The revised final version of the lichen planus guideline was passed on to the European Dermatology Forum (EDF) for a final consensus with the European Academy of Dermatology and Venereology (EADV).

Lichen Planus − the role of the general dental practitioner

Oral lichen planus is frequently encountered in primary and secondary dental care. The soft tissues of the mouth should always be examined carefully at check-ups and any abnormality be palpated to detect change in consistency (induration) along with any changes in colour or general appearance. Such changes should prompt a referral for specialist review. CPD/Clinical Relevance: The general dental practitioner (GDP) can play a simple yet effective role in the management of lichen planus by removing obvious traumatic stimuli, improving oral hygiene and advising on simple topical treatment.

Comparative evaluation of oral corticosteroids versus low molecular weight heparin in the treatment of lichen planus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lichen planus (LP) is an immunologically mediated inflammatory disorder involving the skin, nails, hair follicles and mucous membranes. Though several drugs and phototherapy are tried and mentioned in the literature, dermatologists are still depending on corticosteroids, which have various serious side effects on long term usage. Thus, in search for an alternative therapy, the present study is conducted to compare the efficacy of systemic corticosteroids and low dose low molecular weight heparin in management of lichen planus.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 60 patients with biopsy proven LP were selected and divided randomly into two groups with 30 patients each. Group 1 was treated with oral corticosteroids and group 2 was treated with low molecular weight heparin for 8 weeks. Follow up was done for a period of 6 months, at monthly intervals in all patients and any relapses if any were noted.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 60 patients with biopsy proven LP were selected and divided randomly into two groups with 30 patients each. Group 1 was treated with oral corticosteroids and group 2 was treated with low molecular weight heparin for 8 weeks. Follow up was done for a period of 6 months, at monthly intervals in all patients and any relapses if any were noted.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Low dose enoxaparin in the treatment of lichen planus could be considered as an alternative to oral corticosteroids because of equal efficacy and fewer side effects.&lt;/p&gt;

Drug Delivery Tailored for the Need– Case Series of Oral Lichen Planus

: Lichen planus is an inflammatory mucocutaneous disorder. The pathogenesis of lichen planus is predominantly T cell mediated. The condition is associated with it are hepatitis C, graft versus host disease, medications , dental materials etc. Immune modulators have been widely used in the management of lichen planus. Corticosteroids are the most widely used among them. There is various mode of delivering corticosteroids in oral lichen planus. The systemic administration is reported to cause more adverse drug reaction when compared to local drug delivery systems. The case series describes three cases of lichen planus at different sites. It also high lights the site-specific treatment applied in them.Key words: Lichen planus, Local drug delivery, Corticosteroids, Systemic steroids.

Lichen planus in children

Abstract: Lichen Planus (LP) is a chronic, inflammatory disease of the skin and mucous membranes. It is more frequently seen in the middle-aged and elderly population but can be present in children, although this is relatively rare. This paper describes the presentation and management of lichen planus in children, illustrated by seven cases seen within the Paediatric Dentistry Unit. Dentists should be aware of the condition and understand when referral to a specialist centre is required and the need for multidisciplinary management of complex cases.CPD/Clinical Relevance: Although oral lichen planus is rare in children, it is important that dentists are able to identify its clinical presentation and abnormal changes to the oral mucosa, as well as being aware of possible local and systemic causes of the condition so that reassurance and correct management pathways can be implemented in primary care practice.

Lichen Planus and Its Management: An Update and Observation

Lichen planus (LP) is an inflammatory muco-cutaneous disease characterised by shiny, flat-topped papules and plaques. It affects around 1% of the population. The disease is usually self-limiting and benign in nature. However, some varieties of LP may cause considerable discomfort and recalcitrant in nature. So, treatment depends on appreciating the type, severity and nature of the disease. There are a good numbers of options for treating different types of LP. Few types of LP are difficult to treat and needs aggressive treatment to prevent complications like hair or nail loss. Author examined and summarized the published literature involving the treatment or management of LP. It is found that the large scale, evidence based trials are only few in number. At present, it is quite difficult to standardisation of treatment. This review outlines the ongoing trial and current treatment options. It is needed to assimilation and summarization of the recent findings to treat the critical cases in a more effective way

Assessment of griseofulvin in the management of lichen planus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Oral lichen planus (OLP) is a common mucocutaneous disorder that affects 1-2% of the adult general population and slight predominance in females has been observed. The success rate is not satisfactory with these modalities of treatment, so there is a clear need for alternative therapy. This study was done to evaluate the efficacy of griseofulvin in the treatment of lichen planus.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The present study was conducted in the department of dermatology in the medical institution for the period of one year. The study included the initial assessment of 60 patients who were diagnosed with lichen planus (LP). Patients with both sexes and age between 15-60 years who agreed to come on follow up examination were included. All patients were treated with griseofulvin 500 mg/day for 6 months. Response of treatment was assessed by clinical examination at each subsequent visit (every two weeks)&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Among patients with OLP, there was complete response in 27%, moderate improvement in 51%, and no response in 22% of cases. Complete clinical response of cutaneous LP was seen in 18% cases, no response was found in same number of patient, 64% no. of cases showed moderate response. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Griseofulvin gives complete improvement in 27% cases and moderate improvement in 51% cases in OLP and it gives complete improvement in 16% cases in cutaneous LP after treatment of 6 months. This study was done on a small scale and without any control group, so conclusive comments could not be passed.&lt;/span&gt;&lt;/p&gt;

Physicochemical and in vitro mucoadhesive properties of microparticles/discs of betamethasone for the management of oral lichen planus

This study involved the preparation and evaluation of buccal-mucoadhesive microparticles/discs of bethamethasone disodium phosphate (BDSP). The microparticles were prepared using the emulsion solvent diffusion method. Microparticles were prepared and characterized by encapsulation efficiency particle size, Fourier Transform Infra Red (FTIR) spectrums, Differential Scanning Calorimetric (DSC) thermograms and mucoadhesive properties. FTIR studies reported that BDSP was changed to bethamethasone base molecule inside the intact microparticles. The best drug to polymers ratio in microparticles was F1 containing 50 mg drug, 50 mg HPMC (as non-ionic and hydrophilic polymer) and 50 mg carbomer 934p (an anionic mucoadhesive polymer). The production yield of F1 microparticles was calculated as 78.60% with loading efficiency of about 65.14% and the mean particle size was also measured as 281.84 μm. It was proposed that during the microparticle preparation procedure, water soluble salt of the drug may be converted to the base which could be more effective in the buccal mucosa due to its higher partition coefficient and lipophilicity. The highest and lowest releases resulted from the discs prepared from F1 and F4, respectively, compared with the commercial tablet and untreated drug powder (p < 0.05). The data revealed that the discs exhibited good percentage of mucoadhesion (F1, 326 g/cm2). It may be concluded that drug loaded buccal-mucoadhesive microparticles are a suitable delivery system for BDSP, and may be used in the effective management of lichen planus.

Advance and prospect for the diagnosis and management of lichen planus

口腔扁平苔藓(oral lichen planus,OLP)是常见的口腔黏膜慢性炎性疾病,好发于30～60岁的女性,发病率为0.5％ ～4.0％[1].虽然OLP的发病机制尚未明确,但目前倾向于认为OLP是一类T细胞介导的自身免疫性疾病。

A randomized trial assessing the effectiveness of different concentrations of isotretinoin in the management of lichen planus

The aim of our 10-year study was to test the effectiveness of topical therapy based on 0.18% isotretinoin, comparing it with that most frequently used, i.e. at 0.05% concentration. Seventy patients with an established diagnosis of oral lichen planus were involved in the study. The patients were randomly divided into two groups, and the drug was administered topically at 0.05% and 0.18% concentrations. The drug at the higher concentration, according to the same protocol, was administered to the patients who did not benefit from the therapy at the lower concentration. None of the cases of reticular lichen planus showed clinical or histological improvement. In contrast, the atrophic–erosive forms showed a significant improvement, both clinical and histological: in 26 patients (at 0.18% concentration) and in nine patients (at 0.05% concentration), the symptoms, as well as the erosions or ulcers observed, disappeared. The disappearance of dysplasic phenomena was observed at 0.18% concentration. Topical application of the drug was accompanied by an increase in soreness and pain, as well as greater sensitivity to hot foods. However, these side effects were transitory, and considered acceptable by the patients. The proposed therapeutic protocol was effective towards highly active atrophic–erosive oral lichen planus with dysplasic phenomena, which is the form of the disease at higher risk of malignant evolution.

Treatment of Vulvovaginal Lichen Planus With Vaginal Hydrocortisone Suppositories

Successful treatment of vulvovaginal lichen planus has been elusive. Unchecked, the condition can seriously damage the epithelium and lead to vaginal stenosis and severe vaginal erosion. This study was conducted to investigate the use of hydrocortisone vaginal suppositories in the management of lichen planus of the vulva and vagina. Study subjects were 60 patients (mean age, 58 years; range, 30-84 years) from a private clinic who had been diagnosed with lichen planus between 1986 and 2000. Most women in this study were white (87%), 8% were Hispanic, and 2% were Asian. Patients were generally referred by other physicians after futile treatment for chronic vulvar symptoms, which included burning, pruritus, dyspareunia, and vaginal discharge. Diagnosis was confirmed with biopsy, physical exam, and symptomatic review. Initially 25-mg hydrocortisone vaginal suppositories were used twice a day until symptoms subsided. Treatment was gradually decreased to the lowest dose that provided relief from symptoms. Nine of 16 patients with vaginal stenosis were treated with vaginal dilators. Five women used estrogen cream or lidocaine jelly in addition to the suppositories. Erythema was present in nearly all subjects. Vaginal lesions were seen in 49 (82%) women, and vulvar lesions in 47 (78%) women. Forty percent of patients had oral lesions, and 7% had other areas of skin involvement. Complete pre-and posttreatment data were available for two thirds of the 60 subjects, so analysis was restricted to those 43 patients. The distribution of their symptoms did not differ from the total group. Results were based on patients' reports and on physical findings. There was a significant decrease in symptoms in the posttreatment group. The percentage of women who reported burning symptoms decreased from 72% before treatment to 16% after treatment (P <.001). Symptoms of pruritus and dyspareunia decreased from 26% to 5% (P =.004) and from 65% to 23% (P =.006), respectively. Vaginal discharge was experienced by 49% of patients before treatment and 7% after treatment (P <.001). There was no change in vaginal stenosis. Eighty-one percent of patients reported improved or somewhat improved symptoms, and physical examination found improved or somewhat improved symptoms in 84%. The majority of these patients were not sexually active, but those who were reported no change in their sexual activity. No differences were seen between those whose treatment was successful and those who did not have significant improvement. The mean duration of treatment in this series was 28 months (range, 1-144 months).

Management of oral lichen planus.

Lichen planus is a relatively common disorder of the stratified squamous epithelia. Most dental and medical practitioners see patients with lichen planus, but not all are recognized as having the disease. Patients with lichen planus may have concomitant involvement of the disease in multiple sites. Oral lichen planus lesions usually have a distinctive clinical morphology and characteristic distribution, but oral lichen planus may also present a confusing array of patterns and forms, and other disorders may clinically mimic oral lichen planus. The etiopathogenesis of lichen planus appears to be complex, with interactions between genetic, environmental, and lifestyle factors. Much has now been clarified about the etiopathogenic mechanisms involved and interesting new associations, such as with liver disease, have emerged. The management of lichen planus is still not totally satisfactory in all cases and there is as yet no definitive treatment that results in long term remission, but there have been advances in the control of the condition. Amongst the many treatments available, high potency topical corticosteroids remain the most reliably effective, though topical cyclosporine, topical tacrolimus, or systemic corticosteroids may be indicated in patients whose condition is unresponsive to topical corticosteroids.

Oral lichen planus: The clinical, historical, and therapeutic features of 100 cases

Lichen planus is a chronic inflammatory epidermal and mucosal disease, the cause of which is poorly understood. We reviewed the clinical and historic features of 100 patients referred to our clinic for diagnosis and management of lichen planus. The age, gender, chief complaint, duration of the chief complaint, medical history, medications, and clinical findings were recorded. Past therapeutic modalities were reviewed. Of therapeutic significance, 25 patients with oral lichen planus had a secondary oral candidiasis. Management of symptomatic lichen planus with topical and systemic steroid is discussed. The pharmacology of topical and systemic steroid usage and the rationale for treatment are discussed.