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LETTER TO EDITOR
Year : 2000  |  Volume : 66  |  Issue : 6  |  Page : 330-331

Lichen Planus Treated with Acitretin (le)




Correspondence Address:
R K Pandhi


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Source of Support: None, Conflict of Interest: None


PMID: 20877122

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How to cite this article:
Pandhi R K, Mittal R, Khaitan K B. Lichen Planus Treated with Acitretin (le). Indian J Dermatol Venereol Leprol 2000;66:330-1

How to cite this URL:
Pandhi R K, Mittal R, Khaitan K B. Lichen Planus Treated with Acitretin (le). Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2020 Aug 13];66:330-1. Available from: http://www.ijdvl.com/text.asp?2000/66/6/330/4967


To the Editor,

Lichen planus of the skin and mucous membranes is usually a self limiting eruption. But when extensive and associated with severe pruritus, it may be quite disabling. Systemic therapy is the only way to control the acute presentation of the disease. Various modalities of treatment have been tried-corticosteroids (systemic and topical), PUVA, dapsone, immunosuppressants and retinoids (systemic and topical).[1] We report here a case of lichen planus successfully treated with acitretin.

A 59-year-old man presented with recurrent episodes of generalised, itchy, violaceous papules since 10 years. He was being treated with tablet prednisolone 30 mg daily and also with topical corticosteroids with only minimal and temporary relief. At the time of presentation, he had multiple widespread violaceous flat-topped papules on the trunk, forearms and legs associated with severe itching. He did not have any mucosal, scalp or nail lesions. Histopathological examination from a papule showed features suggestive of lichen planus. On routine baseline investigations, haemogram, liver and renal function tests, lipid profile, urinalysis, examination of stool, chest X-ray and electrocardiogram were within normal limits. Systemic examination was normal. He was treated with acitretin 25mg daily orally. By 2 weeks, all the lesions flattened and the pruritus decreased by 60% and there were no new lesions. The lipid profile and the liver function tests were repeated every month. The patient is still under treatment and there have been no side effects of the therapy.

The cause of lichen planus is not known. Many etiologic mechanisms and associations have been proposed. Dermal T-lymphocytes have been postulated to stimulate the pathogenic mechanism responsible for lichen planus. The activated T cells view keratinocytes as 'target cells' and interact with them. The interferon- ? produced by T cells induce monocyte expression of lymphocyte functionassociated antigen that helps these cells to attach to keratinocytes. The apposition of activated immune cells and corneocytes then leads to destruction of the latter. Cytokines, usually involved in inflammatory processes, may influence the expression of lichen planus. The retinoids are known to possess anti-inflammatory properties, perhaps through their interaction with the arachidonic acid cascade and may alter the cell surface antigens of the keratinocytes.[2] In an evidence based medicine analysis of efficacy, acitretin was found to be the first line therapy in cutaneous lichen planus[3] though corticosteroids are the most widely used therapeutic agents. There have been few isolated trials which show that acitretin is an effective therapy for severe cases of lichen plan us.[4],[5]

We therefore, would like to share our experience of treating lichen planus with acitretin which seems to be an effective and useful drug for lichen planus. We have treated four more patients with systemic retinoids with very satisfactory results, the results of which will soon be published.

 
  References Top

1.Woo TY. Systemic isotretinoin treatment of oral and cutaneous lichen planus. Cutis 1985;35:385-93.   Back to cited text no. 1    
2.Boyd AS, Nelder KH. Lichen planus. J Am Acad Dermatol 1991; 25: 593-619.  Back to cited text no. 2    
3.Cribier B, Frances C, Chosidow O. Treatment of lichen planus. An evidence based medicine analysis of efficacy. Arch Dermatol 1998; 134:1521-1530.  Back to cited text no. 3    
4.De Jong EM, Van De Kerhof PC. Coexistence of palmoplantar lichen planus and lupus erythematous with response to treatment using acitretin. Br J Dermatol 1996; 134: 538-541.   Back to cited text no. 4    
5.Lauberg G, Geiger JIM, Hjorth N, et al. Treatment of lichen planus with acitretin. A double -blind, placebo-controlled study in 65 patients. J Am Acad Dermatol 1991; 24: 434-437.  Back to cited text no. 5    




 

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