Assuntos
Alopecia , Líquen Plano , Naltrexona , Humanos , Alopecia/tratamento farmacológico , Alopecia/patologia , Líquen Plano/tratamento farmacológico , Líquen Plano/diagnóstico , Líquen Plano/patologia , Naltrexona/administração & dosagem , Naltrexona/uso terapêutico , Feminino , Administração Oral , Pessoa de Meia-Idade , Resultado do Tratamento , Masculino , Adulto , Fibrose/tratamento farmacológico , Idoso , Antagonistas de Entorpecentes/administração & dosagem , Antagonistas de Entorpecentes/uso terapêuticoAssuntos
Líquen Plano , Tacrolimo , Humanos , Tacrolimo/administração & dosagem , Tacrolimo/uso terapêutico , Líquen Plano/tratamento farmacológico , Líquen Plano/diagnóstico , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Idoso , MasculinoAssuntos
Líquen Plano , Piperidinas , Pirimidinas , Humanos , Pirimidinas/uso terapêutico , Pirimidinas/administração & dosagem , Piperidinas/uso terapêutico , Piperidinas/administração & dosagem , Líquen Plano/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Inibidores de Proteínas Quinases/administração & dosagem , Feminino , Pirróis/uso terapêutico , Pirróis/administração & dosagem , Pessoa de Meia-Idade , Masculino , Administração Tópica , Administração CutâneaRESUMO
Lichen planus is a chronic auto-inflammatory disease that primarily affects mucocutaneous regions. There are many variants of lichen planus including cutaneous, oral, nail, follicular, and erosive forms. Without any disease-specific treatment options, multi-variant lichen planus can be a challenging disease to manage. We present a 61-year-old woman with multivariant lichen planus that was refractory to numerous systemic and topical therapies. Subsequently, her cutaneous and vulvovaginal lesions improved with the use of oral baricitinib and the erosive oral lesions improved with topical ruxolitinib.
Assuntos
Azetidinas , Líquen Plano , Nitrilas , Purinas , Pirazóis , Pirimidinas , Sulfonamidas , Humanos , Feminino , Pirazóis/uso terapêutico , Pirazóis/administração & dosagem , Nitrilas/uso terapêutico , Pessoa de Meia-Idade , Purinas/uso terapêutico , Purinas/administração & dosagem , Azetidinas/uso terapêutico , Azetidinas/administração & dosagem , Sulfonamidas/uso terapêutico , Sulfonamidas/administração & dosagem , Pirimidinas/uso terapêutico , Pirimidinas/administração & dosagem , Líquen Plano/tratamento farmacológico , Líquen Plano/patologia , Administração OralRESUMO
Lichen sclerosus (LS) is a chronic inflammatory dermatosis primarily affecting the genitalia, commonly characterized by pearly-white papules and plaques. Although predominantly affecting females, LS can manifest across all age groups, with a bimodal distribution observed in prepubescent girls and postmenopausal women. This case report presents an unusual instance of exclusive extragenital LS in a 10-year-old girl, showcasing hyperpigmented patches and wrinkled plaques resembling lichen planus on her forearms and lower legs. Histopathological analysis confirmed LS, revealing distinctive epidermal changes and lymphocytic infiltrates. The absence of mucosal involvement and unique clinical presentation differentiated this case from typical LS manifestations. Treatment with topical clobetasol propionate demonstrated significant improvement in pruritus. Extragenital LS is infrequent, particularly among children, and its diagnosis necessitates a comprehensive clinicopathological correlation. The reported case contributes valuable insights into this uncommon variant, emphasizing the importance of accurate diagnosis and tailored treatment strategies. Additionally, it highlights the efficacy of high-potency topical corticosteroids in managing this condition.
Assuntos
Clobetasol , Líquen Plano , Líquen Escleroso e Atrófico , Humanos , Feminino , Criança , Líquen Plano/patologia , Líquen Plano/tratamento farmacológico , Líquen Escleroso e Atrófico/patologia , Líquen Escleroso e Atrófico/tratamento farmacológico , Clobetasol/uso terapêutico , Antebraço/patologia , Perna (Membro)/patologiaRESUMO
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.
Assuntos
Inibidores de Janus Quinases , Líquen Plano , Qualidade de Vida , Humanos , Líquen Plano/diagnóstico , Líquen Plano/terapia , Líquen Plano/tratamento farmacológico , Inibidores de Janus Quinases/uso terapêutico , Inibidores da Fosfodiesterase 4/uso terapêutico , Produtos Biológicos/uso terapêutico , Pirimidinas/uso terapêutico , Piperidinas/uso terapêutico , Pele/patologia , Talidomida/análogos & derivados , Talidomida/uso terapêutico , Terapia de Alvo Molecular/métodosRESUMO
We present a case of a patient with a 10-year history of blue-black macules and patches on the face and an associated history of skin-lightening cream usage. The skin lightening cream contained hydroquinone, which is often associated with exogenous ochronosis (EO). Interestingly, the biopsy did not show characteristic findings of ochronosis, confusing the final diagnosis, however discontinuing the skin-lightening creams halted the progression of the patient's skin lesions supporting a diagnosis of EO. EO presents as asymptomatic hyperpigmentation after using products containing hydroquinone. This condition is most common in Black populations, likely due to the increased use of skin care products and bleaching cream containing hydroquinone in these populations. Topical hydroquinone is FDA-approved to treat melasma, chloasma, freckles, senile lentigines, and hyperpigmentation and is available by prescription only in the US and Canada. However, with the increased use of skin-lightening creams in certain populations, it is important for dermatologists to accurately recognize the clinical features of exogenous ochronosis to differentiate it from similar dermatoses. An earlier diagnosis can prevent the progression to severe presentations with papules and nodules. We summarize the clinical presentations diagnostic features, and treatment pearls, concluding with a discussion of the differential diagnoses. J Drugs Dermatol. 2024;23(7):567-568. doi:10.36849/JDD.8248.
Assuntos
Hidroquinonas , Hiperpigmentação , Líquen Plano , Ocronose , Humanos , Ocronose/diagnóstico , Ocronose/induzido quimicamente , Hiperpigmentação/induzido quimicamente , Hiperpigmentação/diagnóstico , Hidroquinonas/efeitos adversos , Hidroquinonas/administração & dosagem , Diagnóstico Diferencial , Líquen Plano/diagnóstico , Líquen Plano/induzido quimicamente , Líquen Plano/tratamento farmacológico , Feminino , Preparações Clareadoras de Pele/efeitos adversos , Preparações Clareadoras de Pele/administração & dosagem , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/induzido quimicamente , Dermatoses Faciais/patologia , Dermatoses Faciais/tratamento farmacológico , Pessoa de Meia-Idade , Creme para a Pele/efeitos adversos , Creme para a Pele/administração & dosagemRESUMO
As of now, there exists no established therapy for ELP. Retinoids, which are standard in treating cutaneous LP, do not exhibit positive effects in ELP. While topical glucocorticosteroids often yield favorable responses in esophageal inflammation, some cases prove recalcitrant or refractory. In such instances, various immunosuppressive therapies have been attempted with variable success.This report details a severe case of ELP that showed resistance to prednisolone, acitretin, alitretinoin, adalimumab, tacrolimus, hydroxychloroquine plus mycophenolate mofetil, and cyclophosphamide. The initiation of the JAK inhibitor tofacitinib induced an impressive clinical, endoscopic, and histological remission. This positive response to a JAK inhibitor is discussed in the context of our evolving understanding of the immune-mediated pathogenesis of this disease.
Assuntos
Líquen Plano , Piperidinas , Pirimidinas , Pirróis , Humanos , Piperidinas/uso terapêutico , Piperidinas/efeitos adversos , Pirimidinas/uso terapêutico , Pirimidinas/efeitos adversos , Líquen Plano/tratamento farmacológico , Líquen Plano/induzido quimicamente , Líquen Plano/patologia , Resultado do Tratamento , Pirróis/uso terapêutico , Pirróis/efeitos adversos , Doenças do Esôfago/tratamento farmacológico , Doenças do Esôfago/induzido quimicamente , Doenças do Esôfago/patologia , Indução de Remissão , Pessoa de Meia-Idade , Masculino , FemininoRESUMO
Background and Objectives: Lichen planus of the lip (LPL) is a chronic inflammatory condition that resembles actinic cheilitis, discoid lupus erythematosus, graft-versus-host disease, and lichenoid reaction to dental materials or drugs. The purpose of this study was to conduct a literature review on lichen planus lip involvement and to report a retrospective observational study that characterises and explores the clinical, histopathological, and evolution of the lesions in a group of patients with unique involvement of LPL. Materials and Methods: Clinical data of patients diagnosed with LPL was retrieved from the medical charts of the patients referred to the Oral Pathology Department of the "Carol Davila" University of Medicine and Pharmacy. A concurrent electronic literature research was carried out using PubMed and Web of Science from 2003 to 2023. Results: Eleven patients diagnosed with unique LPL were analysed (male/female ratio was 1.75, mean age 63.64 years ± 12.52). All patients presented lesions of the lower lip; the clinical forms were atrophic (six cases) and erosive (five cases), and the histopathological exam confirmed the diagnosis. After topical treatment with corticosteroids, most of the patients had complete remission. The literature review revealed 24 studies (sixteen case reports and eight case series) which comprised 84 patients. Isolated lip involvement was reported in 17 studies, and five articles with concomitant oral lichen planus, while two articles did not mention this criterion. Conclusions: Our study brings new data on isolated lichen planus of the lip that primarily affects the lower lip with predominance in male patients. It was reported worldwide in patients between 22 and 75 years old. Topical corticosteroids were the main treatment prescribed and they usually brought remission of the lesions. Lichen planus of the lip is a challenging diagnosis for oral health practitioner providers as well as for dermatologists.
Assuntos
Líquen Plano Bucal , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Idoso , Estudos Retrospectivos , Líquen Plano Bucal/tratamento farmacológico , Líquen Plano Bucal/diagnóstico , Lábio/patologia , Líquen Plano/tratamento farmacológico , Líquen Plano/diagnóstico , Adulto , Doenças Labiais/diagnóstico , Doenças Labiais/tratamento farmacológico , Idoso de 80 Anos ou maisRESUMO
Importance: Lichen planopilaris (LPP) is a form of scarring alopecia associated with progressive, permanent hair loss. Symptoms range from burning pain to itching, also carrying substantial psychological morbidity. Yet, disease characteristics, pathophysiology, and effective treatment data are limited, making treatment a challenge. Objective: To describe the prevalence and dermatologist-prescribed treatment patterns of LPP among US adults. Design, Setting, and Participants: This cross-sectional study used the Explorys database. The prevalence analysis used a 15% random sample and identified US adults with LPP diagnoses between 2017 and 2019. The LPP treatment analysis included all patients with LPP diagnoses between 2016 and 2020 and a dermatologist encounter in the first year after diagnosis. Data were analyzed from January 2023 to April 2023. Main Outcomes and Measures: The main outcomes of the prevalence analysis were the crude and standardized prevalence estimates of US adults with LPP across age, sex, and racial groups. The main outcomes of the treatment analysis were the frequency of LPP treatments within 1 year of diagnosis, and the number of patients who continued treatment beyond 1 year, switched treatments, and combined treatments. Results: Among 1â¯466â¯832 eligible patients analyzed for prevalence, 241 patients had an LPP diagnosis (222 [92.1%] female; median [IQR] age, 64 [54-73] years). Standardized overall prevalence was 13.4 per 100â¯000 (95% CI, 11.7-15.1). In the treatment analysis, 991 patients had an LPP diagnosis (907 [91.5%] female; median (IQR) age, 60 [47-69] years). Most received at least 1 type of medication (635 [64.1%]), most frequently intralesional corticosteroids (370 [37.3%]) and topical corticosteroids (342 [34.5%]), followed by doxycycline (104 [10.5%]) and hydroxychloroquine (72 [7.3%]). Treatment continued beyond 1 year in 71 of 200 patients (35.5%) prescribed intralesional corticosteroids and 7 of 29 patients (24.1%) prescribed hydroxychloroquine. Treatment switching at 1 year occurred in 32 of 254 patients (12.6%) first prescribed an intralesional corticosteroid and in 44 of 194 (22.7%) first prescribed a topical corticosteroid. Combinations of 2 or 3 treatment types were given to 137 (13.8%) and 74 (7.5%) patients, respectively. Conclusions and Relevance: This cross-sectional study reported prevalence and treatment patterns for US adults with LPP in a representative sample. Most patients with LPP received treatment, and many received multiple treatment types and switched treatments, suggesting further research into medication selection offers clinical benefit.
Assuntos
Alopecia , Líquen Plano , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Transversais , Prevalência , Líquen Plano/epidemiologia , Líquen Plano/tratamento farmacológico , Adulto , Idoso , Estados Unidos/epidemiologia , Alopecia/epidemiologia , Alopecia/tratamento farmacológico , Adulto Jovem , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/uso terapêuticoRESUMO
Lichen planus (LP) is one of the few conditions that may cause permanent and debilitating nail loss. Recurrence is common despite treatment with first-line therapies including intralesional and systemic corticosteroids. We describe application of a resin nail for recalcitrant LP of the fingernail for improved cosmesis and functionality.
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Líquen Plano , Doenças da Unha , Humanos , Líquen Plano/tratamento farmacológico , Doenças da Unha/tratamento farmacológico , Doenças da Unha/terapia , Feminino , Resinas Sintéticas , Unhas/patologia , Pessoa de Meia-IdadeRESUMO
Context: Lichen planus (LP) is a chronic lichenoid inflammatory disease of the skin, mucosa and appendages. The classic LP symptom is a dense infiltration of inflammatory T cells moving in the upper dermis and arranged in a band-like pattern. Lichen planus has an undetermined aetiology; however, it is known to have immune-mediated pathogenesis. Lichen planus cannot be cured, although treatment can lessen symptoms and shield against further problems. Antihistamines, PUVA (psoralen plus ultraviolet) treatment, retinoic acid, tacrolimus ointment, pimecrolimus cream, as well as corticosteroids are among the most often used therapies. To treat Lichen planus, individualized homeopathic medicine (iHOM) has shown excellent success. Methods: The case was documented at the dermatology OPD (Outpatient Department) of Dr. DY Patil Homoeopathic Medical College and Research Centre. A 32-year-old male patient with lichen planus was treated with individualized homeopathic medicine (iHOM) from March 25, 2021, to August 12, 2021. The results were evaluated at the follow-up visits. An evaluation based on the modified Naranjo criteria was carried out to determine if the alterations were brought on by homeopathic medication. Results: Over a five-month observation period, iHOM medicine produced positive results that physicians may utilize as an additional form of treatment for lichen planus. Conclusion: Individualized homeopathic medicine (iHOM) Nitric acid 30C was prescribed based on the totality of symptoms. Within 5 months, the disease's progression was halted, the itching was controlled, and the lesions flattened.
Assuntos
Homeopatia , Líquen Plano , Humanos , Líquen Plano/tratamento farmacológico , Masculino , Adulto , Homeopatia/métodos , Medicina de PrecisãoRESUMO
INTRODUCTION: Lichen planopilaris (LPP) is a common type of primary cicatricial alopecia. Previous studies focused on the epidemiology, clinical characteristics, and treatment of LPP. A lack of knowledge regarding LPP outcomes and prognostic factors remained. METHODS: To delineate the rate and timing of remission in LPP, as well as the prognostic factors for achieving remission, a retrospective cohort study was conducted. The study included 126 patients, from a single tertiary center, diagnosed with LPP between January 2010 and December 2022, who were followed up for a minimum of 6 months. RESULTS: There were 89 (70.6%) women and 37 (29.4%) men included in this study. The mean age of the patients was 47.92 ± 14.2 years. The mean time from disease onset to diagnosis was 33.85 (±30) months, indicating significant diagnostic delays. The mean duration of follow-up was 34.13 ± 22.7 months. Among the cohort, 43 patients achieved complete remission (CR) during the follow-up period, whereas 83 patients did not. Of the 83 patients who did not achieve CR, 35 partially improved and 48 did not improve or worsened. The median time for achieving CR was 46 ± 18.8 months. Milder disease at presentation and comorbid lichen planus were associated with higher CR rates. CONCLUSION: This study demonstrates significant diagnostic delays that should be addressed as LPP causes irreversible alopecia, suggests disease severity and comorbid lichen planus as potential prognostic factors. Further, it emphasizes the limited efficacy of current treatments and the need for prolonged treatment in patients with LPP to achieve remission.
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Alopecia , Líquen Plano , Indução de Remissão , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Líquen Plano/epidemiologia , Líquen Plano/tratamento farmacológico , Líquen Plano/complicações , Prognóstico , Adulto , IdosoRESUMO
Background: Lichen planus pemphigoides (LPP), an association between lichen planus and bullous pemphigoid lesions, is a rare subepithelial autoimmune bullous disease. Mucous membrane involvement has been reported previously; however, it has never been specifically studied. Methods: We report on 12 cases of LPP with predominant or exclusive mucous membrane involvement. The diagnosis of LPP was based on the presence of lichenoid infiltrates in histology and immune deposits in the basement membrane zone in direct immunofluorescence and/or immunoelectron microscopy. Our systematic review of the literature, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, highlights the clinical and immunological characteristics of LPP, with or without mucous membrane involvement. Results: Corticosteroids are the most frequently used treatment, with better outcomes in LPP with skin involvement alone than in that with mucous membrane involvement. Our results suggest that immunomodulators represent an alternative first-line treatment for patients with predominant mucous membrane involvement.
Assuntos
Líquen Plano , Mucosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Corticosteroides/uso terapêutico , Líquen Plano/tratamento farmacológico , Líquen Plano/patologia , Líquen Plano/imunologia , Líquen Plano/diagnóstico , Mucosa/patologia , Mucosa/imunologia , Penfigoide Bolhoso/imunologia , Penfigoide Bolhoso/tratamento farmacológico , Penfigoide Bolhoso/patologia , Penfigoide Bolhoso/diagnósticoRESUMO
We report the case of an 80-year-old man with restrictive strabismus in lateral gaze following multiple oculoplastic procedures for idiopathic epiphora. Despite excellent initial response to nasal conjunctival recession with lysis of adhesions and a miminal recession of the medial rectus muscle, the patient suffered recurrence of diplopia associated with limitation of abduction due to aggressive, deep, subconjunctival scarring. Given the history of oral lichen planus (LP), the patient was diagnosed with ocular involvement of LP. He underwent a second conjunctival recession, this time accompanied by an intensive LP treatment regimen. Nine months after surgery, he remained diplopia free and orthophoric in primary gaze. Surgeons treating restrictive strabismus in patients with LP should consider implementing systemic and topical immunosuppressive treatment simultaneously with surgical management.
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Recidiva , Estrabismo , Humanos , Masculino , Idoso de 80 Anos ou mais , Estrabismo/cirurgia , Estrabismo/etiologia , Líquen Plano/diagnóstico , Líquen Plano/complicações , Líquen Plano/tratamento farmacológico , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Glucocorticoides/uso terapêutico , Diplopia/etiologia , Diplopia/diagnósticoRESUMO
The aim of this article is to report clinical features and therapeutic approach of cicatrizing keratoconjunctivitis secondary to ocular lichen planus based on a case report. The patient is a 77-year-old female with a history of ocular discomfort and recurrent keratoconjunctivitis that did not improve with conservative treatment, as well as a history of oral and nasal aphthous ulcers. After a complete ophthalmologic, dermatologic and anatomopathological study, the diagnosis of ocular lichen planus was established and immunosuppressive treatment was initiated. Most cases of ocular lichen planus are presented as chronic cicatricial conjunctivitis. A correct differential diagnosis, as well as an early detection are essential for the control of this entity and its sequelae. Treatment, based on corticosteroids and immunosuppressants, both topical and systemic, is aimed at controlling inflammation and scarring.
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Cicatriz , Ceratoconjuntivite , Líquen Plano , Humanos , Feminino , Idoso , Líquen Plano/complicações , Líquen Plano/tratamento farmacológico , Ceratoconjuntivite/etiologia , Ceratoconjuntivite/tratamento farmacológico , Ceratoconjuntivite/complicações , Cicatriz/etiologia , Cicatriz/complicações , Imunossupressores/uso terapêuticoAssuntos
Alopecia , Líquen Plano , Naltrexona , Humanos , Alopecia/tratamento farmacológico , Estudos Retrospectivos , Líquen Plano/tratamento farmacológico , Naltrexona/administração & dosagem , Naltrexona/uso terapêutico , Feminino , Masculino , Pessoa de Meia-Idade , Fibrose/tratamento farmacológico , Resultado do Tratamento , Adulto , Idoso , Antagonistas de Entorpecentes/administração & dosagemRESUMO
INTRODUCTION: Lichen planopilaris (LPP) is one of the most common causes of scarring hair loss caused by immune-mediated inflammation resulting in atrophy and scaling. The key to preventing this irreversible hair loss is diagnosing and starting treatment at the earliest possible stage. As there is no definite cure for LPP, the therapy could be challenging. In the study, we conducted a single-blinded randomized clinical trial to evaluate the therapeutic effects, safety, and tolerability of platelet-rich plasma versus topical clobetasol in the treatment of LPP. METHOD: A randomized single-blinded controlled clinical trial was conducted in 24 LPP patients referring to our dermatology clinic between August 2022 and March 2023. Patients in the control group were treated with topical clobetasol 0.05% applied at night, and patients in the case group, in addition to topical clobetasol, received three sessions of PRP injection monthly. Both groups were assessed 1, 2, and 6 months after the start of the study by the Lichen Planopilaris Activity Index (LPPAI), physician and patient satisfaction, tolerability, and recording adverse effects. RESULTS: The average age in the clobetasol and PRP groups was 43.75 ± 13.51 and 42.75 ± 9.67, respectively (p = 0.83). In terms of gender, all 12 cases (100%) in the clobetasol group and 9 cases (75%) in the PRP group were female (p = 0.21). Both PRP and topical clobetasol effectively reduced LPPAI in the first 2 months; however, after 6 months, the LPPAI significantly increased in the clobetasol group (p = 0.001). There were no significant differences in LPPAI between the two groups at the beginning of the study and after 1 month. However, the mean LPPAI score in the clobetasol group was significantly higher than in the PRP group at 2 and 6 months after the start of the study (p = 0.01). Patient satisfaction with treatment increased in both groups during follow-up sessions, but at the end of the follow-up period, it was significantly higher in the PRP group (p = 0.03). Finally, the study did not have any serious adverse effects, and the pain experienced during PRP injection was tolerable for the patients. Overall, treatment tolerability was excellent in both groups. CONCLUSION: Given the different efficacy profiles, PRP could be considered a new and effective choice for the treatment of LPP.
Assuntos
Clobetasol , Líquen Plano , Satisfação do Paciente , Plasma Rico em Plaquetas , Humanos , Líquen Plano/tratamento farmacológico , Líquen Plano/terapia , Feminino , Adulto , Clobetasol/administração & dosagem , Clobetasol/efeitos adversos , Método Simples-Cego , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Administração Cutânea , Glucocorticoides/administração & dosagem , Alopecia/tratamento farmacológico , Alopecia/terapiaRESUMO
BACKGROUND: Vulvar lichen planus (VLP) is a chronic vulvar dermatosis that is difficult to treat and can severely impair quality of life in the absence of adequate treatment. There is a lack of high-quality evidence to direct therapy for VLP. This randomised controlled trial will be the first double-blinded study comparing systemic treatments in VLP and aims to investigate the safety and efficacy of deucravacitinib compared to methotrexate, in patients with VLP who have failed treatment with potent topical corticosteroids. METHODS: A total of 116 women aged ≥ 18 years with moderate to severe VLP (Genital Erosive Lichen Planus (GELP) score ≥ 5) will be recruited. All participants will initially be treated with Diprosone® OV daily, and their outcome will be assessed using the GELP score. At 8 weeks' follow-up, responders (GELP < 5) will be continued on Diprosone® OV. Non-responders (GELP ≥ 5) will be randomised 1:1 in a blinded fashion to receive (i) methotrexate 10 mg weekly + placebo tablet twice daily + folic acid 5 mg weekly or (ii) deucravacitinib 6 mg twice daily + placebo tablet weekly + folic acid 5 mg weekly. The primary endpoint is the difference in the mean change of GELP scores from baseline to week 32 between deucravacitinib and methotrexate groups. DISCUSSION: High-quality evidence guiding the management of women with VLP is lacking. Once completed, this will be the first double-blinded RCT to compare systemic treatments in VLP. The results of this study will provide valuable, high-quality data to guide second-line therapy options for VLP that is recalcitrant to potent topical corticosteroids. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12623000682640. Registered on 26 June 2023.