Medicines to Treat Lichen Planus

Definition

We speak of lichen planus referring to an immunological inflammatory dermatosis with a chronic course: of pathological interest are the nails, mucous membranes and skin. Since it is a purely immunological pathology, lichen planus is not contagious and is occurs when the immune system recognizes mucous and skin cells as foreign, triggering an unwarranted attack against them.

Causes

Among the predisposing causes, it seems that the familiarity of the disease is the most accredited; in fact, it is not clear which is the main predisposing factor for lichen planus. Environmental factors can also considerably affect the onset of dermatosis.

Hypothetical risk factors not proven: abuse / intake of antiarrhythmic, antihypertensive and NSAID drugs, hepatitis C, Herpes simplex, smoking, excessive stress, hepatitis B vaccine

Symptoms

Since it is a dermatosis, the symptoms that accompany lichen planus are purely cutaneous, although the disease often affects the mucous membranes and nails as well. The general symptom picture of lichen planus is diversified according to the anatomical area involved: itchy, erosive and recurrent papular lesions or plaques on the skin, local itching with balanitis and postitis, resulting in dyspareunia (genital lichen planus), inflammation of the oral mucosa, atrophy of the lingual papillae (oral lichen planus).

The information on Lichen Planus - Medicines for the Treatment of Lichen Planus is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Lichen Planus - Medicines for the Treatment of Lichen Planus.

Medicines

Lichen planus is one of the equivocal diseases, easily confused with other skin diseases; in some patients, lichen planus lasts for life, while the lesions of other patients may regress until they disappear temporarily and reappear after many years.
Pharmacological treatment is indicated to relieve symptoms, improving the living conditions of the patient who is affected by it.
The symptoms of lichen planus can in fact last many weeks or years before regressing, and the chances of reappearance are very high: this explains why continuous treatment is essential to keep the symptomatological picture under control, avoiding its degeneration.
The drugs most used in therapy for the control of symptoms associated with lichen planus are corticosteroids - applied directly to the skin, administered orally or intravenously - retinoids and immunosuppressive drugs. Phototherapy can also be a good aid in the remission of symptoms.
When lichen planus depends on the excessive administration of certain drugs, it is the doctor's duty to change drug therapy and replace that drug with another; again, if the hypothesis of an allergen in the manifestation of lichen planus is suspected, the patient will have to resort to the administration of antihistamines.
Let's now see in more detail the drugs most used in therapy for lichen planus.

The following are the classes of drugs most used in the therapy for lichen planus, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:

Corticosteroids for the treatment of lichen planus: the administration of these drugs is essential to significantly reduce the inflammation associated with dermatosis. Corticosteroids are powerful and equally effective drugs; however, the abuse of these active ingredients, as well as the administration for long periods , can cause serious side effects, such as increasing the risk of vaginal candidiasis, diabetes, hypercholesterolemia and osteoporosis. Corticosteroids can be applied locally or administered systemically.

Triamcinolone (eg Kenacort): parenteral administration of this steroid - as well as all other corticosteroids taken orally or by intravenous injection - can favor osteoporosis, diabetes, hypertension and hypercholesterolemia; it is therefore recommended not to exceed the doses and not to take the product without respecting the doctor's instructions. Indicatively, the dosage of this drug suggests taking 3-48 mg of active per day by intra-lesional injection. Continue therapy by giving one injection every 2-3 weeks.
Betamethasone (eg Celestone, Bentelan, Diprosone): the drug is often formulated in products to be applied locally. Prolonged use of topical betamethasone can promote thinning of the skin, as well as create damage to the adrenal gland and other skin disorders. The drug can also be administered orally, at a dose of 0.6-7.2 mg per day. Consult your doctor for more information.
Clobetasol (eg. Clobesol, Clobetasol PFA): it is recommended to apply the drug directly on the injured skin, twice a day, after careful cleaning and drying of the injured area.
Prednisone (eg. Deltacortene, Lodotra): the dosage must always be established by the doctor based on the severity of the disease and the patient's condition. Indicatively, the dose to be taken varies from 5 to 60 mg per day, possibly divided into several doses (1-4) over the course of 24 hours.

Retinoids: these drugs are also widely used for the treatment of lichen planus; however, they are quite powerful molecules, therefore they must be used with caution, in full compliance with what is prescribed by the doctor. There is no shortage of side effects: the intake of retinoids, even respecting the dosages, can lead to peeling of the skin and erythema; however, it is good to remember that these side effects tend to regress during the period of therapy. It is recommended not to take the drug in pregnancy or during breastfeeding, given its teratogenicity even after a long time from the end of the treatment.

Retinoic acid or tretinoin (eg Retin-A, Vesanoid): the topical treatment with retinoic acid is indicated, in particular, to reduce the itching associated with lichen planus lesions. It is recommended to apply 0.1% retinoic acid, both in the atrophic form and in the erosive variant of lichen. It should be remembered, however, that relapses are very frequent, even following the administration of this drug. Orally, it is possible to take the drug at a dose of 10-60mg / day, either as monotherapy or together with a retinoid applied directly to the skin. Consult your doctor before following such a cure.
Acitretin (eg Neotigason): retinoid to be taken orally. The drug is however used as a second choice to alleviate the symptoms of lichen planus; Acitretin is most used for the treatment of psoriasis. For the dosage: consult your doctor. Do not take during pregnancy and breastfeeding.

Antihistamines: used in therapy when lichen planus lesions create discomfort and itching.

Immunosuppressants: indicated for the severe form of lichen (erosive variant). The most used drug belonging to this category is cyclosporine. It is recommended not to use the drug for long periods, in order to lower the risk of kidney complications.

Ciclosporin (eg Sandimmun Neoral): the administration of this drug is still the subject of discussions and perplexities, particularly in terms of dosage. The various studies have in fact proposed a very variable dosage of this drug, from 50 mg to 1500 mg per day; the efficacy results obtained are equally discordant. It is necessary to report a single case of genital lichen planus which, following the administration of this drug, caused a thorn cell carcinoma.

Local anesthetics: when lichen planus causes painful lesions, anesthetic drugs can be applied locally. For this purpose, lidocaine is one of the most used drugs in therapy which, although not useful for healing, can temporarily relieve pain.

Lidocaine (eg Lidoc C, Ortodermina, Elidoxil) also used to relieve itching in the context of lichen planus. Apply a layer of cream or ointment to the painful skin area: repeat the application 3-4 times a day, as needed. Alternatively, apply up to 3 patches every 12 hours, trying to cover the painful area only when intact. Remove the patch in case of burning or irritation.

Calcineurin inhibitors: in the form of ointments or ointments, these drugs are indicated to treat symptoms of lichen planus affecting the mucous membranes (the same drugs used in therapy after an organ transplant)

Tacrolimus (eg Protopic, Advagraf, Modigraf): immuno-suppressant drug to be applied locally. It is recommended to start the therapy by applying a thin layer of cream, twice a day, massaging gently to allow the drug to be completely absorbed. For the maintenance dose: continue treatment up to 7 days after the absence of symptoms. For children with lichen planus: it is recommended to avoid applying the product to children under the age of 2 years. From 2 to 15 years : apply 0.03% cream, twice a day, up to 7 days after the pain subsides. For children over 15 years of age, it is possible to increase the concentration of the ointment up to 0.1%.
Pimecrolimus (eg Elidel): it is recommended to apply a thin layer of cream in the area affected by the lesion of the lichen planus; repeat the application twice a day, after having cleaned and carefully dried the area. Continue therapy until complete remission of symptoms. If symptoms persist after 6 weeks of treatment, a change in therapy is likely.

Phototherapy: light therapy carried out with UV rays: UVA rays penetrate deep into the skin, while UVB only pass through the superficial layer of the epidermis. It can be useful to alleviate skin symptoms resulting from lichen planus.