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A Case Series With Emphasis on Therapy

Dorothea C. Torti, BA; Joseph L. Jorizzo, MD; Martha Ann McCarty, PA-C

Arch Dermatol. 2007;143(4):511-515.

Background  Oral lichen planus (OLP) is a chronic inflammatory disorder that can cause local irritation and discomfort with attendant poor dentition and nutrition. Although a range of therapeutic options is available, data on the long-term efficacy of treatments for this chronic disease are limited. To identify agents that might be effective in OLP treatment over a longer term, and to explore their sequential use in treatment-refractory patients, we studied patients who received multiple OLP therapies and who were followed up for an average of more than 2 years.

Observations  We performed a retrospective medical record review of 50 patients with histologically confirmed OLP. Patients were treated according to a therapeutic ladder of sequential treatments, beginning with topical corticosteroids and progressing through topical immunomodulators, systemic retinoids, methotrexate, and thalidomide. The best responses were observed in previously untreated patients. Most patients eventually achieved a substantial response with limited toxic effects.

Conclusions  Our results identify low-dose methotrexate as an agent with substantial activity in OLP. We also demonstrate that a laddered therapeutic approach to patients with this disease can achieve substantial lesion regression even in heavily pretreated and treatment-refractory patients.

Author Affiliations: Department of Dermatology, Wake Forest University Health Sciences, Winston Salem, NC (Dr Jorizzo and Ms McCarty); and Dartmouth Medical School, Hanover, NH (Ms Torti).

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