Comparative evaluation of oral corticosteroids versus low molecular weight heparin in the treatment of lichen planus
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20191557Keywords:
Lichen planus, Low molecular weight heparin, Oral corticosteroidsAbstract
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
References
Daoud MS, Pittelkow MR. Lichen planus. In Fitzpatrick's Dermatology in General Medicine, edited by Klaus wolff, Lowell A.Goldsmith.8th edition. New York: Mcgraw-Hill publishers; 2012: 296-312.
Kachhawa D, Kachhawa V, Kalla G, Gupta L. A clinico- aetiological profile of 375 cases of lichen planus. Indian J Dermatol Venereol Leprol. 1995;61:276-9.
Palit A, Inamadar AC. Lichen Planus. Khopkar U, Valia A. 1st edition. Jaypee Brothers Medical Publishers; 2013: 1-7.
Dreiher J, Shapiro J, Cohen AD. Lichen Planus and dyslipidemia:a case-control study. Br J Dermatol. 2009;161:626.
Hodak E, Yosipovitch G, David M, Ingber A, Chorev L, Lider O, et al. Low dose Low molecular weight heparin (enoxaparin) is beneficial in lichen planus. J Am Acad Dermatol. 1998;38:564–8.
Dberker DAR, Menengel AG. Disorders of Hair. In Rook Text Book of Dermatology. Tony Burns Stephen Breathnach, Neilcox, Christopher Griffiths, 7th edition. Oxoford: Blackwell Science Limited; 2004;4:50-51.
Piguet V, Breathnach SM, Cleach L. Lichen Planus and Lichenoid Disorders Chapter 37. Rooks Textbook of Dermatology. 9th edition. 2016.
Silverman S Jr, Bahl S. Oral LP update:Clinical characteristics, treatment responses and malignant transformation. Am J Dent. 1997;10:259.
Sigurgeisson B, Lindel of B. LP and malignancy: An epidemiologic study of 2071 patients and a review of the literature. Arch Dermatol. 1991;127:1684.
Shenoi BSD, Rai VM. Efficacy of Steroid oral mini-pulse therapy in Lichen planus. IJDVL. 2006;72(2):156-7.
Pavlotsky F, Nathansohn N, Kriger G, Shipro D, Trau H. Ultraviolet B treatment for cutaneous lichen planus:our experience with 50 patients. Photodermatol Photoimmunol Photomed. 2008;24:83-6.
Elewa R, Altenburg A, Zouboulis CC. Recalcitrant severe erosive cutaneous lichen planus treated with extracorporeal photopheresis monotherapy. Br J Dermatol. 2011;165:441-3.
Kumar B, Kaur I, Sharma VK. Efficacy of dapsone in lichen planus. Indian J Dermatol Venereol Leprol. 1989;55:164-6.
Elsen D. Hydroxy chloroquine sulfate improves oral LP:An open trial. J Am Acad Dermatol. 1993;28:609.
Buyuk AY. oral metronidazole treatment of LP. J Am Acad Dermatol. 1995;43:260-2.
Asch S, Goldenberg G. Systemic treatment of cutaneous lichen planus: an update. Cutis. 2011;87:129-34.
Mellgren L, Hersle K. Lichen plauns: A clinical study with statistical methods. Ind J Dermatol. 1965;11:1.
Lear JT, English JS. Erosive and generalized LP responsive to Azathioprine. Clin Exp Dermatol. 1996;21:56.
Naparstek Y, Cohen IR, Fuks Z, Vlodavsky I. Activated T-lymphocytes produce a matrix degrading heparin sulfate endoglycosidase. Nature. 1984;310:241-3.
Savion N, Fuks Z, Vlodavsky I. T-lymphycytes and macrophage interaction with cultured vascular endothelial cells: attachment, invasion and subsequent degradation of the subendothelial extracellular matrix. J Cell Physiol. 1984;118:169-76.
Lider O, Mekori YA, Miller T, Bar-Tana R, Vlodavsky I, Baharav E, et al. Inhibition of T-lymphocyte heparinase by heparin prevents T-cell migration and T-cell mediated immunity. Eur J Immunol. 1990;20:493-5.
Ingber A, Trattner A, Cohen IR, Mekori YA. Low doses of Low molecular weight heparin in vivo inhibits the elicitation of contact hypersensitivity. Acta Derm Venereol (Stockh). 1994;74:454-6.
Yusuf SM, Tijjani UA, Maiyaki BM, Nashabaru I, MD, Muhammad S Mijinyawa, MD, Gezawa D Ibrahim. Prevalence and Clinical Spectrum of Lichen Planus in Kano, Nigeria. J Turk Acad Dermatol. 2016;10(3):16103-2.
Abdalla SA, Maaita TJ. Epidemiological and clinical features of lichen planus in Jordanian patients. Pak J Med Sci. 2007;23:92-4.
Kumar V, Garg BR, Baruah MC, Vasireddi SS. Childhood lichen planus (LP). J Dermatol. 1993;20(3):175-7.
Luis-Montoya P, Dominguez-Soto L, Vega-Memije E. Lichen planus in 24 children with review of the literature. Pediatr Dermatol. 2005;22(4):295.
Rao R, Sacchidanand. In: Lichen Planus and lichenoid disorders IADVL Textbook of Dermatology. Sacchid Anand S, editor. 4th edition, Bhalani Publications; 2015: 1090-178.
Pacheco. H, Kerdel F. Successful treatment of lichen planus with low molecular weight heparin;a case series of seven patients. J Dermatol Treatment. 2001;12:123-6.
Stefanidou MP, Ioannidou DJ, Panayiotides JG, Tosca AD. Low molecular weight heparin:a novel therapeutic approach for lichenplanus. Br J Dermatol. 2001;141:1040-5.