mycophenolic-acid and Lichen-Planus

For severe cases of lichen planopilaris (LPP), unresponsive to first line therapy, systemic or potent agents may be required for disease control. There have been several reports of the off-label use of mycophenolate mofetil (MMF) in patients with LPP or have developed adverse effects to initial agents.. A systematic review and meta-analysis was performed according to recommended Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies with ≥5 cases reporting the outcomes of MMF in LPP were pooled and a meta-analysis of proportion was performed. Case reports were excluded from analysis.. A total of six studies were identified and included for meta-analysis, comprising 94 LPP patients. The pooled proportion of any good response (partial or complete) was 69.2% (95% confidence interval (CI): 47.8-77). The pooled proportion of complete response was 20% (95% CI: 10.1-36.3). The pooled proportion of partial responses was 49.2% (95% CI: 30.5-63.7). Side effects occurred in 16.9% (95% CI: 17.6-33.2). of cases, which included elevated LFTs, edema, hyperlipidemia, anemia, herpes zoster infection, photosensitivity, and urinary tract infection.. The current evidence for MMF remains limited. However, it appears to be a potential treatment option for patients with severe or recalcitrant LPP who have failed hydroxychloroquine and other immunosuppressants.

Topics: Humans; Hydroxychloroquine; Immunosuppressive Agents; Lichen Planus; Mycophenolic Acid; Remission Induction

Vulvovaginal lichen planus (VVLP) is a debilitating disease that causes significant pain and psychological distress. Management is made difficult by the chronic course of the disease and its resistance to treatment. While topical steroids have been accepted as the first-line treatment, they fail to achieve symptomatic control in approximately 40% of patients. Second-line therapies include other topical treatments such as calcineurin inhibitors, systemic therapies including oral steroids, methotrexate, mycophenolate mofetil, biologics, and tacrolimus, and procedural options including surgery and dilation, photodynamic therapy, and ultrasound. This review provides an overview of the current treatments and explores the level of evidence supporting each of them.

Topics: Administration, Oral; Administration, Topical; Algorithms; Antibodies, Monoclonal; Calcineurin Inhibitors; Dermatologic Agents; Drug Therapy, Combination; Female; Glucocorticoids; Gynecologic Surgical Procedures; Humans; Lichen Planus; Methotrexate; Mycophenolic Acid; Photochemotherapy; Tacrolimus; Ultrasonic Therapy; Vulvovaginitis

Topics: Adrenal Cortex Hormones; Humans; Lichen Planus; Methotrexate; Mycophenolic Acid; Retinoids

Lichen planus (LP) is a chronic-relapsing inflammatory skin disease. Although many drugs have been used for the management of LP, some of them lack the backup by strong therapeutic evidence, while others are not suitable for some patients due to safety profile issues. The aim of this study was to review the recent status of available medical therapies for LP to help physicians make better decisions upon best medical practice while facing patients with this condition. A review of published articles on management of LP was conducted with the MEDLINE and PubMed databases. The quality of the evidence was graded as high, moderate, low or very low. A total of 1366 articles were retrieved, and 219 (16%) were included in the final analysis. Twenty-one different treatment modalities were analysed. The quality of evidence was high for topical steroid and calcineurin inhibitor, while it was moderate for oral steroids. All the other modalities reached low or very low quality of evidence. Topical steroids and calcineurin inhibitors are the current first-line therapies, while for other therapies the strength of recommendation is not so evident. Unfortunately, larger randomized, controlled trials to support the efficacy, safety and tolerability of other therapies in LP are lacking, and many of them are recommended based on studies with small sample sizes, lack of standardized outcome measures or lack of controlled duration or even in anecdotal evidence. Thus, large-scale randomized clinical trials are still warranted to establish the exact benefits of other topical treatments, phototherapy, immunosuppressant and new immunomodulators for an optimized treatment of LP.

Topics: Administration, Oral; Administration, Topical; Adrenal Cortex Hormones; Antifungal Agents; Calcineurin Inhibitors; Calcitriol; Cyclosporine; Dapsone; Dermatologic Agents; Enoxaparin; Evidence-Based Medicine; Humans; Hydroxychloroquine; Lichen Planus; Methotrexate; Mycophenolic Acid; Retinoids; Tacrolimus; Ultraviolet Therapy

Lichen planopilaris (LPP), a follicular form of lichen planus, is a rare inflammatory lymphocyte mediated disorder. Although the physiopathology is unclear, an autoimmune etiology is generally accepted. Women are affected more than men, and the typical age of onset is between 40 and 60 years. LLP is a primary cicatricial alopecia whose diagnosis is supported in the early stage by both clinical and histopathological findings. Within the margins of the expanding areas of perifollicular violaceous erythema and acuminate keratotic plugs, the histology can show the lichenoid perifollicular inflammation. LPP can be subdivided into 3 variants: classic LPP, frontal fibrosing alopecia (FFA), and Lassueur Graham-Little Piccardi syndrome. With the exception of FFA, the hairless patches of the scalp can be unique or can occur in multiples and can present with a reticular pattern or as large areas of scarring. This condition can have major psychological consequences for the affected patients. The therapeutic management often is quite challenging, as relapses are common after local or systemic treatments. Further research is needed on the pathogenesis, and randomized controlled trials of treatment with scientific evaluation of the results are necessary to appreciate the proposed treatment.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Alopecia Areata; Anti-Inflammatory Agents; Diagnosis, Differential; Female; Humans; Lichen Planus; Male; Middle Aged; Mycophenolic Acid; Recurrence; Scalp Dermatoses; Syndrome

Originally used to treat psoriasis nearly three decades ago, mycophenolic acid, reformulated as mycophenolate mofetil (MMF), has been rediscovered by the world of dermatology. As a relatively well-tolerated immunosuppressive used in organ transplant recipients, MMF has recently been reported to show promise for several dermatologic conditions, including psoriasis, pemphigus vulgaris, pyoderma gangrenosum, bullous lichen planus, and even connective tissue diseases such as lupus erythematosus and dermatomyositis. Although not intended to be exhaustive, this review discusses MMF with regard to its basic pharmacology, its side effects, and its reported efficacy in a variety of dermatologic indications. Relevant literature was retrieved by a Medline search combining the terms "mycophenolate" or "mycophenolic acid" and "skin" or "skin disease" or a number of specific conditions ("psoriasis", "dermatitis", "eczema", "pemphigoid", "pemphigus", "vasculitis", "pyoderma gangrenosum", "Crohn's disease", "graft-versus-host disease", "lichen planus"). As MMF has only been recently re-introduced for dermatologic application, the nature of much of the literature is admittedly that of case reports or case series. Nevertheless, the results are sufficiently promising to warrant further larger, control studies.

Topics: Dose-Response Relationship, Drug; Drug Administration Schedule; Eczema; Female; Graft vs Host Disease; Humans; Lichen Planus; Male; Mycophenolic Acid; Pregnancy; Psoriasis; Pyoderma Gangrenosum; Randomized Controlled Trials as Topic; Risk Assessment; Skin Diseases; Skin Diseases, Vesiculobullous; Treatment Outcome

Lichen planopilaris (LPP) is the most common cause of inflammatory immune-mediated cicatricial alopecia. If not diagnosed and treated properly, it may lead to irreversible hair loss with a devastating impact on quality of life. However, treatment can be a challenge. In an area lacking these sorts of studies, we conducted a randomized controlled trial (RCT) to study the tolerability and therapeutic effects of topical clobetasol versus systemic mycophenolate mofetil (MMF).. A randomized, assessor- and analyst-blinded controlled trial was conducted in 60 patients with LPP in Razi Dermatology Hospital, Tehran, Iran, between February and December 2013. Patients were treated with clobetasol lotion 0.05 % applied at night or oral MMF 2 g/day and were followed for 6 months. The Lichen Planopilaris Activity Index (LPPAI) was the primary measure of response to treatment.. Systemic MMF and topical clobetasol were equally effective in reducing the LPPAI over 6 months of treatment. Treatment tolerability was excellent in both groups and no serious irreversible adverse effects were detected. Satisfaction with treatment rose in the MMF group over time; however, it declined in the clobetasol group.. Given the similar efficacy profiles, topical clobetasol seems to be a more suitable and reasonable choice for treatment of LPP than MMF.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Inflammatory Agents; Clobetasol; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Mycophenolic Acid; Patient Satisfaction; Single-Blind Method; Time Factors; Treatment Outcome

Topics: Female; Humans; Immunosuppressive Agents; Lichen Planus; Methotrexate; Mycophenolic Acid; Retrospective Studies; Vulvar Diseases

Lichen planopilaris (LPP) is a chronic inflammatory disorder of hair without a proven effective and safe treatment. To objectively assess the clinical efficacy of mycophenolate mofetil (MMF) in patients suffering from LPP, a retrospective cohort study was conducted on 52 patients who treated with MMF (2 g/day) at least for 6 months. LPP activity index (LPPAI) before and after treatment was calculated and compared. Most of the patients were female and belonged to the age group of 50-60 years. All of the disease activity indices were significantly improved after 6 months of therapy (p < 0.001). The majority of patients had LPPAI 4-6 and 0-2, before and after treatment, respectively. After 6 months of treatment, half of patients showed a disease activity decrease (LPPAI reduced >25% compared to the baseline value). Systemic MMF is an effective and relatively safe treatment modality for patients with LPP and could lead to significant reduction in disease activity regarding both subjective and objective indices.

Topics: Female; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Mycophenolic Acid; Retrospective Studies; Treatment Outcome

Topics: Aged; Drug Evaluation; Drug Substitution; Drug Tapering; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Mycophenolic Acid; Recurrence; Retrospective Studies; Steroids, Fluorinated; Treatment Outcome

Mucosal lichen planus (MLP) is a therapeutic challenge in need of a new treatment approach because of its debilitating effect on patient's quality of life.. We sought to evaluate a standardized treatment plan for patients with MLP. A second objective was to describe the effect of mycophenolate mofetil in this patient population.. The study retrospectively analyzed 53 patients with MLP treated using a standardized algorithm. The number of MLP lesions, disease activity, and pain at the last visit were compared with baseline scores determined at the initial visit. Results were analyzed using the paired samples t test and confirmed with the Wilcoxon matched pairs signed rank test.. The average number of lesions was reduced from 3.77 to 1.67 (P < .001). The average disease activity was reduced from 2.73 to 0.90 (P < .001). Average pain reported decreased from 2.03 to 1.03 (P < .001).. This study was a retrospective analysis of a small patient population. There was no universal symptom severity scale used at the time of treatment for some patients.. The standardized treatment plan reduced symptoms for patients with MLP. Mycophenolate mofetil appears to be a reasonable treatment option for these patients.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Cohort Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Incidence; Lichen Planus; Lichen Planus, Oral; Male; Middle Aged; Mouth Mucosa; Mucous Membrane; Mycophenolic Acid; Prognosis; Quality of Life; Retrospective Studies; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Treatment Outcome

Erosive genital lichen planus is a disabling, inflammatory mucocutaneous condition that can cause significant patient morbidity and loss of function. Treatment initially involves topical corticosteroids but some patients can have severe treatment-resistant courses requiring systemic immunosuppression. With potentially unfavorable adverse effect profiles and subsequent intolerance of these agents by patients, erosive lichen planus can ultimately be a challenging condition to treat effectively. We present a case of a 66-year-old woman with treatment-resistant erosive genital lichen planus who was successfully managed with mycophenolate mofetil. Although there is only weak evidence for this agent in this condition, its role in dermatology is growing due to its efficacy and advantageous adverse effect profile and should therefore be considered in patients with treatment-resistant erosive genital lichen planus.

Topics: Aged; Female; Genital Diseases, Female; Humans; Immunosuppressive Agents; Lichen Planus; Mycophenolic Acid

Topics: Biopsy; Female; Humans; Immunosuppressive Agents; Lichen Planus; Middle Aged; Mycophenolic Acid; Remission Induction; Skin; Still's Disease, Adult-Onset; Treatment Outcome

Lichen planopilaris (LPP) is a chronic inflammatory disorder that causes permanent scalp hair loss and significant patient discomfort.. We sought to determine the efficacy and safety of mycophenolate mofetil (MMF) for treatment of LPP in patients who had failed prior topical, intralesional, or oral anti-inflammatory medications such as hydroxychloroquine or cyclosporine.. We conducted a retrospective chart review of 16 adult patients with LPP treated with at least 6 months of MMF in an open-label, single-center study from 2003 to 2007. Subjective and objective end points were quantified using the LPP Activity Index (LPPAI) and scores before and after treatment were assessed using a paired t test. Adverse events were monitored.. Patients who completed treatment with MMF had significantly decreased signs and symptoms of active LPP despite having failed multiple prior therapies (P < .005). Five of 12 patients were complete responders (LPPAI score decreased>85%), 5 of 12 patients were partial responders (LPPAI score decreased 25%-85%), and two of 12 patients were treatment failures (LPPAI score decreased<25%). Four patients withdrew from the trial because of adverse events.. Retrospective analysis and small sample size were limitations.. MMF was effective at reducing the signs and symptoms of active LPP in 83% of patients (10 of 12) who had failed multiple prior treatments after at least 6 months of treatment.

Topics: Adult; Aged; Alopecia; Female; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Mycophenolic Acid; Scalp Dermatoses; Severity of Illness Index

Mycophenolate mofetil (MMF) is an immunosuppressive drug that has recently been used to treat autoimmune and inflammatory skin diseases. We report the first case of lichen planopilaris (LPP) successfully treated with MMF. The treatment of our patient demonstrates a novel therapeutic option for patients with LPP; MMF treatment may be preferable to azathioprine treatment because MMF has a safer adverse-effect profile. Larger studies must be performed to establish the risk-benefit ratio of various therapeutic dosages of MMF for these patients.

Topics: Adult; Alopecia; Humans; Immunosuppressive Agents; Lichen Planus; Male; Mycophenolic Acid; Pruritus; Remission Induction; Scalp Dermatoses; T-Lymphocytes

Lichen planus pemphigoides (LPP) and pemphigoid nodularis are rare clinical variants of bullous pemphigoid (BP), which are characterized by histological findings of lichen planus (LP) and nodular prurigo, respectively, and the finding of linear deposits of IgG and/or C3 at the basement membrane zone in perilesional skin. In both cases bullae may arise at the site of pre-existing LP-like or nodular prurigo-like eruptions, and clinically uninvolved skin. The disease spectrum of LPP and pemphigoid nodularis differs from that of classical BP phenotype, and their presentations are often indolent. LPP may predominantly affect a younger age group and is responsive to standard treatments used in acquired autoimmune bullous diseases, while pemphigoid nodularis is more common in elderly women and is relatively resistant to therapy. We describe a patient who had LPP for nearly two decades and subsequently developed a nodular eruption with a concurrently detected antibullous pemphigoid antigen 2 (BP180) autoantibody. His overall clinicopathological features were indicative of LPP evolving into another BP variant, pemphigoid nodularis.

Topics: Autoantigens; Azathioprine; Carrier Proteins; Collagen Type XVII; Cytoskeletal Proteins; Dystonin; Enzyme-Linked Immunosorbent Assay; Humans; Immunoglobulin G; Immunoglobulins, Intravenous; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Mycophenolic Acid; Nerve Tissue Proteins; Non-Fibrillar Collagens; Pemphigoid, Bullous; Treatment Outcome

Lichen planus (LP) is an inflammatory skin disorder with a wide range of clinical appearances. The treatment of disseminated and especially erosive forms of LP is often difficult and disappointing. Activated T cells are important in the pathogenesis of LP as indicated by the dermal lymphocytic infiltrate leading to keratinocyte destruction and lesion formation. Similar histologic findings are present in graft-versus-host disease. Since T cells are key players in the development of both disorders and mycophenolate mofetil has been successfully introduced in the treatment of graft-versus-host disease, we have examined the therapeutic potential of this agent in 3 patients suffering from disseminated and erosive LP. Mycophenolate mofetil was well tolerated and induced complete remission in 2 patients, and substantial improvement in the third patient.

Topics: Adolescent; Adult; Female; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Mycophenolic Acid

Topics: Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Blister; Female; Glucocorticoids; Humans; Hypertrophy; Immunosuppressive Agents; Lichen Planus; Middle Aged; Mycophenolic Acid; Prednisone; Treatment Outcome