IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 2471 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
   Article in PDF (96 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References

 Article Access Statistics
    Viewed5808    
    Printed74    
    Emailed8    
    PDF Downloaded256    
    Comments [Add]    
    Cited by others 5    

Recommend this journal

 


 
LETTER TO EDITOR
Year : 2006  |  Volume : 72  |  Issue : 2  |  Page : 156-157

Efficacy of steroid oral mini-pulse therapy in lichen planus: An open trial in 35 patients


Department of Skin and STD, Kasturba Medical College and Hospital, Manipal, Karnataka, India

Correspondence Address:
Vandana Mehta Rai
Department of Skin and STD, Kasturba Medical College and Hospital, Manipal, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0378-6323.25650

Rights and Permissions



How to cite this article:
Ramesh M, Balachandran C, Shenoi S D, Rai VM. Efficacy of steroid oral mini-pulse therapy in lichen planus: An open trial in 35 patients. Indian J Dermatol Venereol Leprol 2006;72:156-7

How to cite this URL:
Ramesh M, Balachandran C, Shenoi S D, Rai VM. Efficacy of steroid oral mini-pulse therapy in lichen planus: An open trial in 35 patients. Indian J Dermatol Venereol Leprol [serial online] 2006 [cited 2019 Jun 17];72:156-7. Available from: http://www.ijdvl.com/text.asp?2006/72/2/156/25650


Sir,

Lichen planus (LP) is an inflammatory papulosquamous disorder presenting with violaceous, polygonal, flat-topped, pruritic papules and plaques on the flexor surface of the glabrous skin, mucous membrane and nail. Though the exact cause of LP is unknown, the current concept of pathogenesis includes genetic and immunologic factors. Systemic glucocorticoids are the mainstay of dermatologic therapy because of their potent immunosuppressive and anti-inflammatory properties, but their long-term use may lead to various side effects.

To avoid or minimize the side effects of daily steroids, we evaluated the efficacy of oral mini-pulse (OMP) therapy with betamethasone in LP in an open uncontrolled study design. Thirty-five patients with classical LP and not on any active medication were enrolled in the study. Patients with a history of gastritis, tuberculosis, uncontrolled diabetes mellitus and hypertension and pregnant and lactating women were excluded. Baseline investigations and skin biopsy for histopathology and direct immunofluorescence were performed in all patients. The blood pressure and weight were recorded initially and monitored every month.

All patients received 6 mg of betamethasone phosphate orally once a week for 3-6 months. If no improvement was seen after 6 months, it was considered as treatment failure. Follow-up assessment was done monthly to assess the severity of pruritus, appearance of new lesions, percentage of improvement and side effects of steroid treatment. The severity of pruritus was graded on a scale of 0 (none), 1 (mild), 2 (moderate) and 3 (severe). The percentage of improvement was calculated as follows:

100% - Complete subsidence of all lesions,

absence of pruritus and no new lesions

76-100% -A few elevated lesions, itching is absent

or mild, but there are no new lesions

51-75% - Most lesions remain elevated, mild to

moderate, but no new lesions

<50% - Most lesions remain elevated, itching is

moderate to severe and new lesions

Patients were examined for side effects such as weight gain, hypertension, gastritis, acneiform eruption, striae and cushingoid features.

Of the 35 patients, 19 (54.28%) patients were males and 16 (45.71%) were females with ages between 18 to 65 years. The duration of LP was less than 6 months in 28 patients (80%) and more than 6 months in 7 patients (20%). Severe pruritus was seen in 16 (45.7%) patients.

Twenty (57.14%) patients showed complete cure or 100% improvement, of which 13 (37.14%) improved in 3 months and 7 (20%) in 5 months. Six (17.14%) patients showed 76-100% improvement, two (5.71%) patients showed 51-75% improvement and three (8.57%) patients showed <50% improvement. The lesions in all cases healed with hyperpigmentation. Four (11.42%) patients dropped out of the study, including two due to side effects. After discontinuing treatment the disease relapsed in five (14.28%) patients after an average duration of 3 months. Side effects due to treatment were seen in 20 (57.1%) patients; most commonly weight gain, insomnia and epigastric pain.

Corticosteroids have been used as a therapeutic modality for LP topically, intralesionally or systemically.[1],[2] Even though daily oral steroid therapy is highly effective, long-term use may result in serious side effects. To avoid these side effects, pulse therapy was conceived. Dexamethasone-cyclophosphamide pulse therapy in pemphigus patients has been widely accepted.[3] Oral mini-pulse therapy may be used for longer periods with minimal side effects as compared to daily corticosteroid therapy. Even if a relapse occurs, the therapy may be repeated and remission may be achieved in a large proportion of cases. In our study, the response was good to excellent in 88.5% patients. We therefore conclude that betamethasone oral mini-pulse therapy is a convenient and fairly effective treatment modality for extensive lichen planus.

 
  References Top

1.Verma KK, Mittal R, Manchanda Y, Khaitan BK. Lichen planus treated with betamethasone oral minipulse therapy. Indian J Dermatol Venereol Leprol 2000;66:34-5.  Back to cited text no. 1    
2.Kelett JK, Ead RD. Treatment of lichen planus with a short course of oral predisolone. Br J Dermatol 1990;123:550-51.  Back to cited text no. 2    
3.Pasricha JS, Khaitan BK, Raman RS, Chandra M. Dexamethasone cyclophosphamide pulse therapy for pemphigus. Int J Dermatol 1995;34:875-82.  Back to cited text no. 3  [PUBMED]  



This article has been cited by
1 Systemic treatment of cutaneous lichen planus: An update
Asch, S., Goldenberg, G.
Cutis. 2011; 87(3): 129-134
[Pubmed]
2 Severe chronic urticaria treated with oral mini-pulse steroid therapy
Godse, K.V.
Indian Journal of Dermatology. 2010; 55(4): 402-403
[Pubmed]
3 Efficacy of sulfasalazine in the treatment of generalized lichen planus: randomized double-blinded clinical trial on 52 patients
M Omidian, A Ayoobi, MA Mapar, A Feily, B Cheraghian
Journal of the European Academy of Dermatology and Venereology. 2010;
[VIEW] | [DOI]
4 Pulsed itraconazole therapy in eruptive lichen planus
Khandpur, S., Sugandhan, S., Sharma, V.K.
Journal of the European Academy of Dermatology and Venereology. 2009; 23(1): 98-101
[Pubmed]
5 Pulsed itraconazole therapy in eruptive lichen planus
S Khandpur,S Sugandhan,VK Sharma
Journal of the European Academy of Dermatology and Venereology. 2009; 23(1): 98
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow