isotretinoin and Lichen-Planus

Systemic isotretinoin has been used to treat severe acne vulgaris for 20 years. However, isotretinoin also represents a potentially useful choice of drugs in many dermatologic diseases other than acne vulgaris. Diseases such as psoriasis, pityriasis rubra pilaris, condylomata acuminata, skin cancers, rosacea, hidradenitis suppurativa, granuloma annulare, lupus erythematosus and lichen planus have been shown to respond to the immunomodulatory, anti-inflammatory and antitumor activities of the drug. Isotretinoin also helps prevent skin cancers such as basal cell carcinoma or squamous cell carcinoma. A combination of systemic isotretinoin and interferon-alpha-2a may provide a more potent effect than isotretinoin alone in the prevention and treatment of skin cancers.Systemic isotretinoin may be considered as an alternative drug in some dermatologic diseases unresponsive to conventional treatment modalities. However, randomized clinical trials aimed at determining the role of systemic isotretinoin therapy in dermatologic diseases other than acne vulgaris are required.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Condylomata Acuminata; Dermatologic Agents; Drug Therapy, Combination; Granuloma Annulare; Hidradenitis Suppurativa; Humans; Isotretinoin; Keratolytic Agents; Lichen Planus; Lupus Erythematosus, Systemic; Pityriasis Rubra Pilaris; Psoriasis; Rosacea; Sebaceous Glands; Skin Diseases; Skin Neoplasms

Treatment of frontal fibrosing alopecia (FFA) is complicated and challenging. In this study, we evaluated the efficacy of combining topical tacrolimus with isotretinoin versus finasteride in patients with FFA.. Thirty-one patients with FFA were divided randomly into two groups. Therapeutic regimen of the first group (group A, n = 16) was isotretinoin and tacrolimus (Capsule isotretinoin 20 mg daily and topical tacrolimus 0.1% BD). The second group (group B, n = 15) was given finasteride and tacrolimus (Tablet finasteride 2.5 mg daily and topical tacrolimus 0.1% BD). Patients were treated and followed up periodically for 12 weeks. Evaluation of the treatment efficacy was based on Patient Global Assessment and Physician Global Assessment scales. Objective evaluation was based on improving the severity of skin lesions by viewing serial images taken from the affected areas.. Physician Global Assessment (PGA) was significantly better in the group A as compared with the group B at 4 weeks (p = 0.038). Physician satisfaction in the group A was better than the group B at 12 weeks, but this was not statistically significant (p > 0.05). Patient Global Assessment and patient satisfaction in the group A was better than the group B at 8 and 12 weeks, but it was not statistically significant (p > 0.05).. Although both therapeutic regimens were effective in the treatment of FFA, treatment with tacrolimus and isotretinoin is significantly more effective than tacrolimus and finasteride.

Topics: Alopecia; Finasteride; Humans; Isotretinoin; Lichen Planus; Tacrolimus; Treatment Outcome

Facial papules reflecting the lichenoid inflammation of facial vellus hair follicles can occur in the backgrounds of frontal fibrosing alopecia, lichen planopilaris (LPP), or even alone. In the present study, we aimed to compare systemic and topical isotretinoin in the treatment of facial LPP.. In a prospective randomized trial, 26 patients with facial LPP were randomly allocated to receive either 20 mg/day oral isotretinoin or isotretinoin 0.05% gel every night for 6 months. Global Aesthetic Improvement Scale (GAIS) and patient's satisfaction questionnaire were used at 1, 3, and 6 months after treatment to evaluate the outcomes.. In both oral and topical isotretinoin groups, facial papules were significantly improved at all follow-up visits, resulting in statistically significant improvements (p = 0.005 and p = 0.007, respectively, for oral and topical groups) in GAIS score mean difference from month 1 to month 6. Overall levels of patient satisfaction were high in both groups, and no significant difference was observed between two groups (p = 0.107). However, the mean GAIS score at 3 and 6 months after treatment showed significantly greater improvements in oral isotretinoin group compared to topical group (1.85 ± 0.62 vs. 1.03 ± 0.49 at month 3, p = 0.004; 2.45 ± 54 vs. 1.59 ± 0.62 at month 6, p = 0.008). Overall, patients could well tolerate the treatments; however, topical therapy was associated with fewer side effects.. Both oral and topical isotretinoin were found to be effective in improving facial papules; however, oral isotretinoin was significantly more efficacious. Considering safety profile of topical isotretinoin, it can be administrated as maintenance therapy for patients with facial LPP.

Topics: Alopecia; Humans; Isotretinoin; Lichen Planus; Prospective Studies

In a double-blind study, 20 patients with oral lichen planus were treated twice daily with 0.1% isotretinoin gel or the vehicle alone for two months. Subsequently, patients who used the placebo received the active preparation for another two months. Patients treated with the active medication displayed significantly greater improvement than patients receiving the placebo. Patients who were treated initially with the placebo showed statistically significant improvement after receiving the topical isotretinoin treatment for two months. Side effects from using the gel were primarily a transient burning sensation or irritation on initial application.

Topics: Administration, Topical; Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Isotretinoin; Lichen Planus; Male; Middle Aged; Mouth Diseases; Tretinoin

Lichen planus is an inflammatory disease affecting the skin and mucosal membranes often with a chronic course lasting months to years with episodes of relapses. Classically it presents as flat topped, purple, polygonal, pruritic papules on the volar aspect of wrists and forearms, ankles, lower legs, and lumbo-sacral spine. We report a young woman with an exanthematous/eruptive variant of lichen planus who had a sudden outbreak of multiple papules and plaques all over the body with relative sparing of head and neck region. Eruptive lichen planus is rarely reported in adults and effective treatments are not well documented. We prescribed a short course of oral corticosteroid to which the patient did not respond. This was followed by oral isotretinoin and there was dramatic improvement in her symptoms and cutaneous lesions. A short course of oral corticosteroid followed with oral isotretinoin may be considered as a valuable management plan for exanthematous lichen planus. This combination may avoid serious adverse effects of both drugs when prescribed in high doses.

Topics: Adrenal Cortex Hormones; Exanthema; Female; Humans; Isotretinoin; Lichen Planus; Skin

Topics: Alopecia; Humans; Isotretinoin; Lichen Planus

Lichen planopilaris (LPP) is an immune-mediated cicatricial alopecia. The main clinical presentations of LPP include classic form, frontal fibrosing alopecia (FFA), and Graham-Little-Piccardi-Lassueur syndrome (GLPLS). We reviewed medical records of all 291 patients diagnosied with LPP from 2006 to 2017 in Department of Dermatology, Tehran University of Medical Sciences. LPP was more common in women than men. Lichen planus (LP) was seen in 59 of patients (20.3%). Parietal lesions (69.75%), frontal (27.14%), occipital (23.71%), and temporal (21.64%) were frequently seen in LPP patients. However, trunk hair involvement (15.4% vs. 2.7%;

Topics: 5-alpha Reductase Inhibitors; Adult; Cyclosporine; Female; Hair Follicle; Humans; Iran; Isotretinoin; Lichen Planus; Male; Methotrexate; Middle Aged; Retrospective Studies; Treatment Outcome

Topics: Alopecia; Humans; Isotretinoin; Lichen Planus; Skin Abnormalities

Topics: Alopecia; Fibrosis; Humans; Isotretinoin; Lichen Planus

Topics: Alopecia; Fibrosis; Humans; Isotretinoin; Lichen Planus

Topics: Adult; Alopecia; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Lichen Planus; Male; Middle Aged

Lichen planus pigmentosus (LPP) is a cosmetically distressing pigmentary disorder often posing a therapeutic challenge. Isotretinoin has been shown to be effective in oral and cutaneous LP, but its role in LPP is yet unknown.. To evaluate the efficacy and safety of isotretinoin in the management of LPP.. In this prospective study, 32 clinically and histologically proven patients with LPP were recruited. Subjects were treated with fixed low-dose (20 mg/day) oral isotretinoin once daily for 6 months along with topical sunscreens. Response was graded as mild (<25%), moderate (26-50%), and good (>50%) improvement based on decrease in intensity and progression of hyperpigmentation.. Twenty-seven patients (17 females and 10 males), aged 20-62 years, completed the study. Twenty-three (85.2%) patients had active disease and pruritus at presentation. Treatment outcome was moderate improvement in 15 patients (55.7%) followed by good in seven (21.8%) and mild in two (6.2%). Pruritus subsided at the earliest at 9-14 days, and disease stabilized by 4-6 weeks in treatment-responsive patients. Patients with a shorter duration (≤5 years) of disease and limited body area involvement had a better outcome.. Low-dose isotretinoin seems to be a promising treatment modality in stabilizing and decreasing the pigmentation in LPP particularly in early and limited disease.

Topics: Adult; Body Surface Area; Dermatologic Agents; Female; Humans; Hyperpigmentation; Isotretinoin; Lichen Planus; Male; Middle Aged; Pilot Projects; Prospective Studies; Pruritus; Time Factors; Treatment Outcome; Young Adult

Topics: Acitretin; Administration, Oral; Adult; Aged; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Isotretinoin; Keratolytic Agents; Lichen Planus; Male; Middle Aged; Steroids

Topics: Female; Gingival Diseases; Humans; Isotretinoin; Lichen Planus; Lichenoid Eruptions; Middle Aged; Vaginal Diseases; Vulvar Diseases

Topics: Dermatologic Agents; Humans; Isotretinoin; Keratolytic Agents; Lichen Planus; Retinoids; Tretinoin

Topics: Administration, Topical; Adult; Aged; Female; Humans; Isotretinoin; Lichen Planus; Male; Middle Aged; Mucous Membrane; Tretinoin

Topics: Administration, Topical; Cell Count; Humans; Isotretinoin; Langerhans Cells; Lichen Planus; Mouth Diseases; Mouth Mucosa; Random Allocation; Tretinoin

Six patients with symptomatic oral erosive lichen planus were treated with systemic isotretinoin (10 to 60 mg daily) for 8 weeks. Five (83%) showed subjective and objective improvement at completion of therapy, but the improvement was slight. Relapse occurred in four patients within 2 months after the drug was stopped; one was lost to follow-up. Because of the minimal improvement and adverse side effects, no patient wished to be re-treated with isotretinoin.

Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Isotretinoin; Lichen Planus; Male; Middle Aged; Mouth Diseases; Recurrence; Tretinoin

Lichen planus of the skin and mucous membranes may be disabling. Severe pruritus or bullous lesions may be incapacitating when they occur while erosive oral lesions may be extremely painful. Various treatment modalities have been attempted including corticosteroids (parenteral, intralesional, and topical) and photochemotherapy. Recent successful therapeutic trials of topical retinoic acid and oral etretinate have been completed. Two patients with cutaneous and severe erosive oral lichen planus unresponsive to conventional therapies responded to a trial of oral isotretinoin with prompt and successful remission of cutaneous and oral lesions. This suggests that systemic isotretinoin may have a unique position in the treatment of mucous membrane lichen planus that is refractory to conventional therapies.

Topics: Administration, Oral; Female; Humans; Isomerism; Isotretinoin; Lichen Planus; Middle Aged; Mouth Diseases; Mouth Mucosa; Prednisone; Tretinoin

Topics: Humans; Isomerism; Isotretinoin; Lichen Planus; Tretinoin