tretinoin and Lichen-Planus--Oral

Therapy-resistant lichen planus (LP) can be a challenging condition for dermatologists. There are some case reports about successful treatments with alitretinoin of cutaneous and oral, but not of esophageal LP.. We present the unique case of a patient with cutaneous, oral and esophageal LP which was refractory to classical treatment options (topical clobetasol propionate and pimecrolimus, intramuscular triamcinolone acetonide); because of systemic side effects the patient did not tolerate systemic acitretin dosed up to 25 mg daily.. Oral alitretinoin was used at a dose of 30 mg daily.. Both oral and skin changes as well as dysphagia completely resolved within 4 weeks without any severe side effects and the drug was used for 6 months. No papules, intraoral striae or dysphagia recurred during the 6 months of treatment. After 4 months the patient relapsed with mucosal patches so that a second cycle was initiated for 6 months where oral LP lesions resolved after 4 weeks also (with sporadic mild headache).. Further studies are needed to better understand the impact of alitretinoin in LP. Our observation suggests alitretinoin as a new, well-tolerated treatment option for esophageal LP after failed response to conventional treatments.

Topics: Alitretinoin; Antineoplastic Agents; Deglutition Disorders; Esophageal Diseases; Female; Humans; Lichen Planus; Lichen Planus, Oral; Middle Aged; Tretinoin

The treatment of oral lichen planus (OLP) remains a real challenge for clinicians who deal with this patient population and thus with diagnosis of this disease. Most treatment failures are attributable to improper diagnosis. Therefore, before a patient is started on therapy, a biopsy must be done and the diagnosis established. Most patients with OLP are asymptomatic, and once the diagnosis is established, patients need to be seen once a year to monitor their disease. However, when OLP is symptomatic, it can interfere with the patient's everyday life, making it difficult to work and to eat. The most symptomatic forms of the disease are the erosive and atrophic types. Often, systemic therapy is the only way to control the acute presentation of the disease. The most effective treatment modality to control the signs and symptoms of the disease is short courses of systemic steroids (prednisone) and topical high-potency corticosteroids. Other forms of therapy include the use of cyclosporine (topical) and retinoids, both systemic (etretinate) and topical (tretinoin). However, there is no one single standard protocol proven effective with either systemic retinoids or topical cyclosporine. Results so far are controversial and not very encouraging. One aspect clinicians must remember when designing treatment protocols for erosive OLP is the chronic course of the disease and its recalcitrant nature. These factors mean that treatment has to be long, and the onset of adverse side effects from long-term therapy must be taken into account. Alternate-day treatment protocols, low doses, and adjunct therapy all should be considered when a new agent is being considered for treating erosive OLP.

Topics: Administration, Topical; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Biopsy; Clinical Protocols; Cyclosporine; Eating; Etretinate; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Keratolytic Agents; Lichen Planus, Oral; Prednisone; Recurrence; Treatment Failure; Tretinoin; Work

Patients with severe oral lichen planus refractory to standard topical treatment currently have limited options of therapy suitable for long-term use. Oral alitretinoin (9-cis retinoic acid) was never systematically investigated in clinical trials, although case reports suggest its possible efficacy.. To assess the efficacy and safety of oral alitretinoin taken at 30 mg once daily for up to 24 weeks in the treatment of severe oral lichen planus refractory to standard topical therapy.. We conducted a prospective open-label single arm pilot study to test the efficacy and safety of 30 mg oral alitretinoin once daily for up to 24 weeks in severe oral lichen planus. Ten patients were included in the study. Primary end point was reduction in signs and symptoms measured by the Escudier severity score. Secondary parameters included pain and quality of life scores. Safety parameters were assessed during a follow-up period of 5 weeks.. A substantial response at the end of treatment, i.e. >50% reduction in disease severity measured by the Escudier severity score, was apparent in 40% of patients. Therapy was well tolerated. Adverse events were mild and included headache, mucocutaneous dryness, musculoskeletal pain, increased thyroid-stimulating hormone and dyslipidaemia.. Alitretinoin given at 30 mg daily reduced disease severity of severe oral lichen planus in a substantial proportion of patients refractory to standard treatment, was well tolerated and may thus represent one therapeutic option for this special group of patients.

Topics: Administration, Oral; Alitretinoin; Antineoplastic Agents; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Lichen Planus, Oral; Male; Middle Aged; Mouth Mucosa; Pilot Projects; Prospective Studies; Recurrence; Retinoid X Receptors; Severity of Illness Index; Time Factors; Treatment Outcome; Tretinoin

The purpose of this study was to compare the efficacy of retinoic acid in an oral base 0.05% with fluocinolone acetonide in an oral base 0.1% in the treatment of atrophic and erosive oral lichen planus. Thirty-three patients with histologically proven oral lichen planus were asked to participate in the study. Lesions were scored ranging from 0 (no lesion) to 5 (large erosion) according to the severity. Patients were randomly assigned to receive either topical fluocinolone acetonide or topical retinoic acid. They were instructed to apply the medication on dried lesions four times a day. The lesions were evaluated after 2 and 4 weeks of treatment. The sign scores were analyzed by the Wilcoxon rank sum test. Eighteen patients receiving topical fluocinolone acetonide improved from the average score of 3.0 to 1.5 after 4 weeks of treatment, whereas 15 patients receiving topical retinoic acid showed little change (average score, 2.9 and 2.4, respectively). The changes were statistically significantly different between the two groups (p = 0.01). The results suggest that 0.1% fluocinolone acetonide reduced the severity of atrophic and erosive oral lichen planus better than 0.05% retinoic acid.

Topics: Administration, Oral; Administration, Topical; Adult; Anti-Inflammatory Agents; Female; Fluocinolone Acetonide; Glucocorticoids; Humans; Keratolytic Agents; Lichen Planus, Oral; Male; Middle Aged; Statistics, Nonparametric; Treatment Outcome; Tretinoin

In earlier work, we demonstrated that 0.1 p. 100 topical tretinoin is clinically effective and well tolerated compared with placebo for the treatment of oral leukoplakia and oral keratosic or erythematous lichen planus. Here we aimed to complete this clinical protocol with histological and biochemical analyses comparing the biopsy specimens collected at inclusion and those collected after 4 months of treatment. Histological results were based on changes in keratinization observed between onset of treatment and 4 months treatment. Biochemical studies included the use of antibodies (anti-cytokeratins 10-11, anti-filaggrine) for the immunohistochemical evaluation of keratinization and 2-dimensional gel electrophoresis for measuring cytokeratins. In patients with lichen planus, histological changes during treatment showed that, in the 10 patients in the tretinoin group, keratinization disappeared in 6 and decreased significantly in 3. Immunohistochemistry revealed that cytokeratins 10-11 and filaggrin disappeared in 57 p. 100 of the patients treated with tretinoin versus 25 p. 100 in the patients given placebo. Bidimensional gel electrophoresis showed that cytokeratins 1, 2, 10 and 11 disappeared only in the tretinoin group (60 p. 100 of the cases). In patients with leukoplakia, histological changes during treatment showed that, in the tretinoin group, keratinization disappeared in 5 cases and decreased in 5 others. Immunohistochemistry revealed that cytokeratins 10-11 disappeared in 30 p. 100 of the patients treated with tretinoin versus 25 p. 100 in the placebo group. Bidimensional electrophoresis demonstrated that cytokeratins 1, 2, 10 and 11 disappeared in 43 p. 100 of the patients treated with tretinoin.

Topics: Administration, Topical; Electrophoresis, Gel, Two-Dimensional; Filaggrin Proteins; Humans; Immunohistochemistry; Keratins; Leukoplakia, Oral; Lichen Planus, Oral; Mouth Mucosa; Treatment Outcome; Tretinoin

A randomized study was conducted to evaluate the effect of tretinoin and patient tolerance to treatment with topical applications in series of 20 cases of smoking-related or traumatic oral keratoses leukoplakia and of 20 cases of lichen planus. In each group, patients applied the topical ointment containing tretinoin (10 patients) or placebo (10 patients) twice daily. Clinical outcome was evaluated on the basis of the surface area of the lesion, measured monthly during treatment, as compared with the area observed at treatment onset. After 4 months treatment, there was a significant decrease in the surface area of the lesion in the patients with lichen planus (p < 0.02): 94 p. 100 in the tretinoin group versus 21.4 p. 100 in the placebo group. In patients with leukoplakias, there was also a very significant reduction in the surface area of the lesion after 4 months of treatment (p < 0.001): 80 p. 100 in the tretinoin group and 16 p. 100 in the placebo group. Tolerance to treatment was generally good despite a few complaints of quite temporary burning sensation at application rapidly resolutive.

Topics: Administration, Topical; Aged; Double-Blind Method; Drug Evaluation; Drug Tolerance; Female; Humans; Leukoplakia, Oral; Lichen Planus, Oral; Male; Middle Aged; Mouth Mucosa; Treatment Outcome; Tretinoin

Lichen planus (LP) is a mucocutaneous disease of chronic inflammatory nature. Although many therapeutic options are available, none are curative. The aim of this article was to describe a therapeutic algorithm that take into consideration the clinical futures of oral LP (OLP).. Patients affected by symptomatic OLP were enrolled into three groups to receive cyclosporine mouthwash, retinoic acid lotion 0.05%, and autologous platelet-rich plasma (PRP) gel in the treatment of reticular, plaque-like, and erosive-type respectively. The products were applied as follows: retinoic acid BID for 8 weeks, cyclosporine mouthwash OD for 8 weeks, PRP once a week for 8 weeks. Patients were assessed at 2, 4, 8, and 12 weeks. Improvement was evaluated as complete response, partial response and no response.. A total of 20 Caucasian patients, 8 male and 12 female, mean age 56 years (range 40-74) concluded the study. Seven patients showed a complete response, 7 patients a partial response, and 6 patients no response.. We propose a therapeutic algorithm that take into consideration the clinical features and symptoms of OLP. Long-term experience on larger series of cases are necessary to confirm our data.

Topics: Administration, Topical; Adult; Aged; Algorithms; Cyclosporine; Female; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Male; Middle Aged; Phenotype; Pilot Projects; Platelet-Rich Plasma; Time Factors; Treatment Outcome; Tretinoin

To evaluate disease dynamics, treatment results, and frequency of malignant transformation. Ten-year single center retrospective study. The study included 171 patients, 28-99 years old. Follow-up was 1-16 years. 49.5% exhibited changes in clinical presentation, with 19% yearly increase of probability for type shift. Index of extent (number of oral locations) showed a mean 40% decrease and 94.1% reported improvement. There were significant differences between treated and untreated patients (P=0.012). Patients with or without systemic diseases had identical treatment requirements for oral lesions. The prevalence of SCC was 5.8%. Oral lichen planus constantly changes presentation and extent of involvement. The effect of systemic diseases was insignificant in the present study. There is a clear value for treatment to reduce the extent of lesions. The results indicate that all clinical forms of the disease need to be equally followed since the clinical presentation typically changes over time, while malignant transformation can occur in all forms.

Topics: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Carcinoma, Squamous Cell; Cell Transformation, Neoplastic; Clobetasol; Dexamethasone; Female; Humans; Lichen Planus, Oral; Male; Middle Aged; Mouth Neoplasms; Precancerous Conditions; Prednisone; Prevalence; Retrospective Studies; Tacrolimus; Tretinoin; Triamcinolone