Definition
We talk about lichen planus referring to an inflammatory immunologic dermatosis with chronic course: pathological are nails, mucous membranes and skin. Since it is a purely immunological pathology, lichen planus is not contagious and occurs when the immune system recognizes mucous and skin cells as foreign, triggering an unjustified attack against them.
Causes
Among the predisposing causes, it seems that the familiarity of the disease is the most accredited; it is not in fact clear which is the main factor predisposing lichen planus. Even environmental factors can significantly affect the onset of dermatosis.
- Unspecified hypothetical risk factors: abuse / taking of antiarrhythmic drugs, antihypertensives and NSAIDs, 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. The general symptomatic picture of lichen planus is diversified according to the anatomical area involved: papular lesions or itchy, erosive and recurrent plaques on the skin, local itching with balanitis and postitis, with consequent dyspareunia (lichen planus genital), inflammation of the oral mucosa, atrophy of the lingual papillae (oral lichen planus).
Information on Lichen Planus - Drugs 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 - Lichen Planus Treatment Medicines.
drugs
Lichen planus is among 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.
Lichen planus symptoms can in fact last several weeks or years before regressing, and the chances of reappearance are very high: this explains why continuous treatment is essential to keep the symptomatic picture under control, avoiding its degeneration.
The most widely used drugs 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 for symptom remission.
When lichen planus depends on the over-administration of some drugs, it is the duty of the doctor to change drug therapy and replace that drug with another; still, if the hypothesis of an allergen is suspected in the manifestation of lichen planus, the patient will have to resort to the administration of antihistamines.
Let us now look in more detail at the drugs most commonly used in lichen planus therapy.
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 assets, as well as the administration for long periods, can cause serious secondary effects, such as increasing the risk of vaginal candidiasis, diabetes, hypercholesterolemia and osteoporosis. Corticosteroids can be applied topically or administered systemically.
- Triamcinolone (eg. Kenacort): parenteral administration of this steroid - as well as for all other corticosteroids taken orally or by intravenous injection - can promote osteoporosis, diabetes, hypertension and hypercholesterolemia; it is therefore recommended not to exceed the doses and not to take the product without following the doctor's instructions. As an indication, the dosage of this drug suggests taking 3-48 mg of active per day by intra-lesion injection. Continue the 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 may promote thinning of the skin, as well as 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 damaged 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 on the basis of the severity of the disease and the patient's condition. Indicatively, the dose to be taken varies from 5 to 60 mg a day, possibly divided into several doses (1-4) during the 24-hour period.
Retinoids : these drugs are also widely used for the treatment of lichen planus; however, they are rather powerful molecules, therefore they must be used with caution, in full respect of what is prescribed by the doctor. Side effects are not lacking: the intake of retinoids, even respecting the dosages, can lead to peeling of the skin and erythema; however, it should be remembered that these side effects tend to recede during the therapy period. It is recommended not to take the drug during pregnancy or during breastfeeding, given its teratogenicity even after a long time after the end of the treatment.
- Retinoic acid or tretinoin (eg Retin-A , Vesanoid ): 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 the lichen. It should be remembered, however, that recurrences are very frequent, even after the administration of this drug. Orally, the drug can be taken at a dose of 10-60mg / day, either as a single agent or together with a retinoid applied directly to the skin. Consult your doctor before following a similar treatment.
- Acitretin (eg. Neotigason): retinoid to be taken orally. The drug is however used as a second choice to lighten the symptoms of lichen planus; Acitretin is more used for the treatment of psoriasis. For the dosage: consult a 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 the 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 reduce the risk of renal complications.
- Ciclosporina (eg Sandimmun Neoral): the administration of this drug is still the subject of discussion and perplexity, in particular in terms of dosage. The various studies have in fact proposed a very variable dosage of this drug, from 50 mg to 1500 mg a day; the efficacy results obtained are equally conflicting. It is necessary to report a single case of genital lichen planus which, following the administration of this drug, caused a spino cell carcinoma.
Local anesthetics: when lichen planus causes painful lesions, it is possible to apply locally anesthetic drugs. For this purpose, lidocaine is one of the most widely used drugs in therapy which, although not useful for healing, can temporarily relieve pain.
- Lidocaine (eg Lidoc C, Orthodermine, Elidoxil) also used to appease pruritus in the context of lichen planus. Apply a layer of cream or ointment in 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 part 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 the 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 completely absorb the medication. 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 the 0.03% cream, twice a day, up to 7 days after the disappearance of the pain. For children over the age of 15, it is possible to increase the ointment concentration up to 0.1%.
- Pimecrolimus (eg. Elidel): it is recommended to apply a thin layer of cream in the area affected by the lichen planus lesion; repeat the application twice a day, after having cleaned and thoroughly dried the area. Continue therapy until complete remission of symptoms. If symptoms persist after 6 weeks of treatment, it is probably necessary to change therapy.
Phototherapy: light therapy performed with UV rays: UVA rays penetrate deep into the skin, while UVB rays pass only through the superficial layer of the epidermis. It can be useful to lighten the skin symptoms that derive from lichen planus.
