| The Lichen
planus/ El liquen plano.
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****** DATA-MEDICOS *********
EL LIQUEN PLANO / THE LICHEN PLANUS
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***** DERMAGIC-EXPRESS No 3 ****
****** 16 OCTUBRE DE 1.998 *******
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EDITORIAL:
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Saludos amigos Dermágicos, tal como les comente ayer, les traigo hoy unos
articulos interesantes sobre el liquen plano.
Saludos a todos...
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DERMAGIC/EXPRESS(3)
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E L L I Q U E N P L A N O / LICHEN PLANUS
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REFERENCIA: 1: Asociacion con vacunación contra hepatitis B
REFERENCIA: 2: Asociación con Hepatitis C
REFERENCIA: 3: Respuesta a tratamiento con LEVAMIZOL y PREDNISOLONA
REFERENCIA: 4: Respuesta a tratamiento con Heparina.
REFERENCIA: 5: Asociación con VPH en lesiones orales
REFERENCIA: 6: Respuesta a tratamiento con Interferon.
REFERENCIA: 7: Respuesta a tratamiento con glycyrrhizin (LICORICE), esta
referencia va cerrada pues la base de datos no ofreció mas. La monté, pues
el LICORICE planta de origen CHINO esta siendo USADA para enfermedades
virales, y se esta hablando de asociación de LP con Hepatitis.
ACTUALIZACION: The skin letter therapy:
STUART MADDIN JULIO 1998: ORAL LICHEN PLANUS
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1.) [Lichen planus and vaccination against hepatitis B]
TO: Lichen plan et vaccination anti-hepatite B.
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AU: Lefort-A; Dachary-D; Vergier-B; Boiron-G
AD: Service d'Anatomopathologie, Hopital du Haut Leveque, Pessac.
SO: Ann-Dermatol-Venereol. 1995; 122(10): 701-3
ISSN: 0151-9638
PY: 1995
LA: FRENCH; NON-ENGLISH
CP: FRANCE
AB: INTRODUCTION: The association of lichen planus with liver diseases is
now well established. Lichen planus following hepatitis B vaccination are
much more unusual. We report here the fifth case of this kind. CASE REPORT:
A 16 years old girl developed a purely cutaneous lichen planus one week
after the first injection of hepatitis B vaccine Gen Hevac B (Institut
Pasteur), which appeared again 3 days after the second injection. The
histologic features shown lichenoid pattern with intense keratinocytes
necrosis more in favor of lichenoid drug eruption than lichen planus.
DISCUSSION: According to our knowledge, only four similar cases have been
previously reported. Comparison between the different vaccines used shows
that only the HBs antigen and its epitope S could be involved in the lichen
planus eruption. Our case is specific due to the early appearance of the
eruption after the first injection and by its histologic features.
CONCLUSION: New cases of lichen planus following hepatitis B vaccination
should help to explain the causal relationship between lichen planus
eruption and hepatitis B vaccination.
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2.) TI: [Lichen planus and hepatitis C virus. Apropos of 5 new cases]
TO: Lichen plan et virus de l'hepatite C. A propos de 5 nouveaux cas.
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AU: Hyrailles-V; Peyron-N; Blanc-P; Mark-Y; Meunier-L; Meynadier-J;
Larrey-D; Michel-H
AD: Service d'Hepato-Gastroenterologie, Hopital Saint-Eloi, Montpellier.
SO: Gastroenterol-Clin-Biol. 1995 Oct; 19(10): 833-6
ISSN: 0399-8320
PY: 1995
LA: FRENCH; NON-ENGLISH
CP: FRANCE
AB: Lichen planus is an immunologically mediated skin or mucous disease,
which has recently been described in some patients with hepatitis C
virus-related liver disease. We report 5 new cases of the association of
hepatitis C with lichen planus, to be added to the 15 cases published in
the literature. The sex ratio (female/male) was of 1.2. Lichen planus
occurred more frequently in chronic active hepatitis (2/3 of cases) than in
cirrhosis (1/3 of cases). Lichen planus manifestations were only mucous
(30%), only cutaneous (40%) or both (30%). Mucous lesions were mainly
observed in patients with cirrhosis (3/4 of cases). The onset of skin and
hepatic manifestations was variable, with liver disease as the most
frequent revealing symptom (60%). The influence of interferon remains
unclear. However, it seemed to trigger more than to relieve lichen planus.
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TI: 3.) Dramatic response to levamisole and low-dose prednisolone in 23
patients with oral lichen planus: a 6-year prospective follow-up study.
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AU: Lu-SY; Chen-WJ; Eng-HL
AD: Department of Dentistry, Ghang Gung Memorial Hospital, Kaohsiung,
Taiwan, Republic of China.
SO: Oral-Surg-Oral-Med-Oral-Pathol-Oral-Radiol-Endod. 1995 Dec; 80(6): 705-9
ISSN: 1079-2104
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: The purpose of this prospective study was to evaluate the short-term
and long-term clinical efficacy of levamisole used with low-dose
prednisolone in patients with refractory oral lichen planus. Twenty-three
patients with OLP who had been treated unsuccessfully with other modalities
were given 150 mg/day levamisole and 15 mg/day prednisolone for 3
consecutive days each week. Twelve patients showed dramatic remission of
signs and symptoms within 2 weeks, whereas 11 had partial remission. All 23
reported significant pain relief and showed no evidence of erosive oral
lichen planus after 4 to 6 weeks of treatment. All 23 also remained free
from symptoms for 6 to 9 months after the treatment ended. There were few
side effects from this treatment besides minor skin rash, headache, and
insomnia from the levamisole in three cases. We conclude that the addition
of levamisole to prednisolone may produce improved results in the
management of erosive oral lichen planus.
MESH: Administration,-Oral; Adult-; Aged-;
Anti-Inflammatory-Agents,-Steroidal-therapeutic-use;
Biological-Response-Modifiers-therapeutic-use; Drug-Therapy,-Combination;
Follow-Up-Studies; Levamisole-therapeutic-use; Middle-Age;
Prednisolone-therapeutic-use; Prospective-Studies; Treatment-Outcome
MESH: *Anti-Inflammatory-Agents,-Steroidal-administration-and-dosage;
*Biological-Response-Modifiers-administration-and-dosage;
*Levamisole-administration-and-dosage; *Lichen-Planus,-Oral-drug-therapy;
Abstrato journal American Academy Dermatology Abril 1.998
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4.) Low-dose low-molecular-weight heparin (enoxaparin) is beneficial in
lichen planus: a preliminary report
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Emmilia Hodak, MD,a Gil Yosipovitch, MD,a Michael David, MD,a Arieh Ingber,
MD,b
Liran Chorev, MD,b Ofer Lider, PhD,c Leora Cahalon, PhD,c and Irun R.
Cohen, MDc
Petah Tikva, Tel Aviv, Jerusalem, and Rehovot, Israel
Background: Low-dose heparin devoid of anticoagulant activity inhibits
T-lymphocyte heparanase activity, which is crucial in T-cell migration to
target tissues.
Objective: The purpose of this study was to assess the efficacy of low-dose
enoxaparin (Clexane), a low-molecular-weight heparin, as monotherapy in
lichen planus.
Methods: Included in the study were 10 patients with widespread
histopathologically
proven lichen planus (LP) associated with intense pruritus of several
months' duration. Patients were given 3 mg enoxaparin, subcutaneously once
weekly; three patients received four injections, and seven patients
received six injections.
Results: In nine patients the itch disappeared within 2 weeks. Within 4 to
10 weeks
in eight of these patients, there was complete regression of the eruption
with residual postinflammatory hyperpigmentation; in one patient, there was
marked improvement. In one patient, no effect was observed. Of the four
patients who also had oral LP, only one showed improvement. No side effects
were observed in any of the patients.
Conclusion: These findings indicate that enoxaparin may be a simple,
effective treatment for cutaneous LP. (J Am Acad Dermatol 1998;38:564-8.)
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5.) TI: [Detection of human papillomavirus (HVP)-DNA in oral manifestation
of lichen planus]
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TO: Nachweis humaner Papillomavirus (HPV)-DNA bei oraler Manifestation von
Lichen planus.
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AU: Vesper-M; Riethdorf-S; Christoph-E; Ruthke-A; Schmelzle-R; Loning-T
AD: Abteilung fur Mund-, Kiefer- und Gesichtschirurgie,
Universitatskrankenhaus Eppendorf.
SO: Mund-Kiefer-Gesichtschir. 1997 May; 1(3): 146-9
ISSN: 1432-9417
PY: 1997
LA: GERMAN; NON-ENGLISH
CP: GERMANY
AB: Human papilloma viruses (HPV) can be detected in different epithelia
with the help of the polymerase chain reaction (PCR). The role of HPV in
the development of anogenital cancers has been intensively studied, and
current evidence shows that most cervical cancers are associated with
so-called high risk HPV types (e.g. HPV 16 and 18). HPV-infections can also
be demonstrated in oral premalignant lesions and squamous cell carcinomas.
Depending on the sensitivity of the detection method, 40-67% of
leukoplakias, 2.5-76% of squamous cell carcinomas and 0-87% of cases of
lichen planus were described to be infected with HPV 16 or 18. Whether
lichen planus can be considered as a premalignant lesion is still
controversial. By the use of PCR and hybridization we found infections with
the high risk HPV types 16, 18 and 31 in 42% (3/7) of the patients with
lichen planus. Further investigations with a higher numbers of cases in
combination with the analysis of the viral gene expression as well as the
clinical and histological control of the corresponding regions are
necessary. The aim of these studies is to find out the prognostic value of
the HPV infection for this facultative premalignant disease.
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6.) TI: Successful treatment of generalized lichen planus with recombinant
interferon alfa-2b.
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AU: Hildebrand-A; Kolde-G; Luger-TA; Schwarz-T
AD: Department of Dermatology, University of Munster, Germany.
SO: J-Am-Acad-Dermatol. 1995 Nov; 33(5 Pt 2): 880-3
ISSN: 0190-9622
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: Three patients with generalized lichen planus were treated with
interferon alfa-2b. The therapy was tolerated well by all patients with
only minor side effects. A response was observed within 2 to 3 weeks.
Itching and erythema decreased first, followed by gradual flattening and
disappearance of papules and plaques after 8 to 10 weeks of treatment.
After 12 weeks, therapy was discontinued after stepwise dosage reduction.
In two patients, minor lesions recurred during dosage reduction. Both
flares were controlled by readministration of interferon.
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7.) TI: A case of oral lichen planus with chronic hepatitis C successfully
treated by
glycyrrhizin
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AU: Nagao-Y; Sata-M; Tanikawa-K; Kameyama-T
SO: Kansenshogaku-Zasshi. 1995 Aug; 69(8): 940-4
ISSN: 0387-5911
LA: ENGLISH
AN: 96083310
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8.) STUART MADDIN SKIN LETTER THERAPY JULIO 1.998
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Oral Lichen Planus: Treatment Options
Estimates of the percentage of patients with cutaneous lichen
planus (LP)
who also have oral LP vary from somewhere between a third and a
half1-3,
to as high as 70%4 and even higher when the cutaneous lesions are
of long
duration.4 Some 251-85%2-4 of patients present with only oral LP.
Although about 65% of patients with cutaneous LP go into spontaneous
remission after one year, such remissions have been estimated to
occur in
no more than 3% of patients with oral LP.5
The underlying mechanism causing LP is thought to be a T-cell mediated
immune response against foreign or autogenous antigens.6 At least two
thirds of
the patients with LP are between the ages of 30-60 and the disease is
uncommon in the very young and in the elderly.7 Oral lichen planus
(LP), if
erosive or disseminated can be very resistant to treatment. Oral LP has
many clinical presentations, with some lesions requiring no treatment
and others needing management for decades.
Treatment rationale
Topical corticosteroids should be considered the treatment of choice
unless the
disease is very extensive.1,2 Systemic therapy is reserved for those
with severe, refractory disease.3
Oral hygiene1-3 and corrective dentistry1-4 play a major role in the
management of LP and consultation with a dentist or oral medicine
specialist may be helpful.6
Acitretin, combined with topical corticosteroid, can be effective,
but should be
reserved for patients who have not responded to corticosteroids
alone. The
retinoid should be used for several months and then tapered as
patients
improve.3 If acitretin is ineffective, other agents such as
antimalarials,
azathioprine or cyclosporine1 have been used.
Dental treatment
Indifferent oral hygiene leading to the formation of plaque and calculus
exacerbates gingival LP, which may lead to severe gingivitis and
periodontal
disease.3 An optimal oral hygiene regimen should be instituted in all
patients with
oral LP, especially those with gingival involvement. Medical therapy should
accompany oral hygiene measures.3 Certain oral clenching and sucking habits
can make LP erosive or ulcerative, and habit splints have helped to modify
these habits and reduce the inflammation.4 Oral trauma from ragged broken
teeth and sharp prostheses are provocative.1 There is some evidence that
the
presence of gold and mercury amalgam fillings may provoke oral lichenoid
reactions. Only a very small percentage of patients will respond to
improved oral hygiene and corrective dentistry without further
intervention.1,2
Lichen planus and hepatic disease
According to European reports hepatic disease does play a role in LP,
its role
seems to be less important in North America.1,2 Nevertheless, it is
reasonable to
obtain pertinent laboratory evidence on newly diagnosed patients,
especially
those with erosive disease.1,3
////CONTROVERSIAL, PUES LAS REFERENCIAS HABLAN DE ASOCIACION CON HEPATITIS
B Y C////
Practice points
1% of patients with oral LP will develop oral squamous cell
carcinoma.2
The relative importance of reversible causes of lichenoid
eruptions, such
as exposure to causative drugs (most commonly diuretics and
non-steroidal anti-inflammatory agents), or hypersensitivity
reactions to
dental restorations has not been determined but a proper
history should
be obtained prior to instituting therapy.3
Secondary candidiasis should be suspected when acute
exacerbations
develop in patients being treated with chronic topical or
systemic steroids
or other forms of immunosuppression.3
There is increasing evidence that many women have concomitant
lichen
planus vulvar involvement, which either they are unaware of or
decline
to mention to their dermatologists. Female patients should be
examined
for vulvar involvement, or at least asked about symptoms.1
Penile lesions
are common.
There are significant histologic differences between
idiopathic lichen
planus and a lichenoid drug eruption. It's important to do a
baseline
biopsy to distinguish between these two entities and to have
these
biopsies read by a dermatopathologist.
Patients who consume alcoholic beverages which contain flakes of
gold (Goldschlagger®, Gold Rush®, Gold Strike®) are at
increased risk
of developing generalized lichen planus. These drinks are more
popular in
Western Europe, especially with younger individuals, so in
such patients
inquiring about their patterns of alcohol consumption is
prudent.1
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References
1.Boyd AS. Personal communication March, 1997.
2.Rogers RS. Personal communication May, 1997.
3.Eisen D. Personal communications March, 1997 and June, 1998.
4.Conklin RJ. Personal communication March, 1997 and June 1998.
5.Chosidow O, Cribier B. Treatment of lichen planus: what is the
right
choice. Med & Surg Dermatol 1998; 5: 49-52
6.Miles DA, Howard MM. Diagnosis and management of oral lichen
planus. Dermatol Clin 1996; 14: 281-290.
7.Arndt KA. Lichen planus. In: Fitzpatrick TB, Eisen AZ, Wolff K
et al,
eds. Dermatology in General Medicine. New York: McGraw-Hill,
1993.
8.Maddin WS, Editor
9.Becherest PA, Bussel A, Chosidow O et al. Extracorporeal
photochemotherapy for chronic erosive lichen planus. Lancet
1998; 351:
805.
10.Hodak E, Yosipovitch G, David M et al. J Am Acad Dermatol 1998;
38: 564-8.
Therapy for oral lichen planus
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First line
topical
corticosteroids
Good safety & efficacy, low cost4 used on
almost all patients.3,4
topical retinoids
Of value when combined with topical
corticosteroids in conditions such as LP of
the gingiva.3
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Second line
acitretin
May be first choice in severe, resistant
disease.8
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Other
dapsone,
hydroxychloroquine
oral corticosteroids
and
immunosuppressives
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No large, well designed trials.4
Hydroxychloroquin is very effective when
topical therapy fails but many months of
treatment are required to realize its
benefits.3
Use oral corticosteroids with caution for a
short term. Azathioprine has also been
used as a steroid-sparing agent.
Cyclosporin does not appear to be better
than topical corticosteroids4 and is very
expensive.3,4
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Investigational
(results need
confirmation and
these two new
treatment
approaches need
further study)
Extracorporeal
photochemotherapy
All seven patients in an open, prospective
trial had complete remission of their
chronic, erosive, oral LP, after 12 sessions
over 1.5 months on average.9
Enoxaparin (a low
molecular weight
heparin)
Low doses given to 10 patients with
intensly pruritic LP produced complete
remission of non-oral skin lesions in eight
patients and marked improvement in one;
oral lesions improved in one out of four
patients with oral LP.10
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DATA-MEDICOS/DERMAGIC-EXPRESS No (3) 16/10/98 DR. JOSE LAPENTA R.
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Dr. Jose Lapenta R.
Maracay Venezuela
[email protected]
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