tretinoin and Lichen-Planus

Treatment of nail lichen planus (LP) is difficult and an optimal therapy is lacking.. To report additional cases to the scant existing literature to learn more about therapeutic options for nail LP.. A regimen of 30 mg alitretinoin daily in 2 cases of nail LP over a period of 9 and 8 months, respectively.. In either case, nail changes showed marked improvement under oral alitretinoin therapy within 2 and 4 months, respectively. In both patients, affected nails with end-stage destructive pterygium were resistant to any previously applied therapy.. Alitretinoin is an effective treatment option for nail LP. We recommend early diagnosis of nail LP and early initiation of systemic therapy with alitretinoin to prevent the development of pterygium and permanent nail damage. However, further clinical studies are needed to establish reliable guidelines for nail LP therapy.

Topics: Alitretinoin; Antineoplastic Agents; Female; Fingers; Humans; Lichen Planus; Male; Middle Aged; Nail Diseases; Nails, Malformed; Tretinoin

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

Topical vitamin A acid (VAA) has various mechanisms of action which may be responsible for its therapeutic success in many different disorders. Although the absorption, metabolism, and excretion of VAA are not completely understood, VAA appears to remain mainly on the skin surface. The question of carcinogenicity is unresolved, and more research is needed to clarify this problem. This article reviews the literature regarding the therapeutic uses of VAA and summarizes various investigators' experiences with VAA.

Topics: Acne Vulgaris; Animals; Callosities; Cocarcinogenesis; Fox-Fordyce Disease; Humans; Ichthyosis; Keloid; Keratoacanthoma; Keratosis; Lichen Planus; Melanoma; Melanosis; Molluscum Contagiosum; Nevus; Psoriasis; Skin Absorption; Skin Diseases; Skin Neoplasms; Tretinoin

Twenty-five patients with oral lichen planus confirmed by histologic examination were divided into three groups: 10 patients received topical treatment with tretinoin, 10 received systemic treatment with etretinate, and the five remaining patients, who received no treatment, served as a control group. An immunopathologic study with the use of monoclonal antibodies was carried out before and after the 3-month course of treatment and showed a variation in the distribution and phenotype of inflammatory cells. No difference between the two types of treatment was observed, but treated patients had a shorter evolution of the disease when compared with control patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antigens, Differentiation, T-Lymphocyte; CD3 Complex; CD4 Antigens; CD4-Positive T-Lymphocytes; CD8 Antigens; Etretinate; Female; HLA-DR Antigens; Humans; Leukocyte Count; Lichen Planus; Male; Middle Aged; Mouth Diseases; Receptors, Antigen, T-Cell; T-Lymphocytes, Regulatory; Tretinoin

Mucosal dysplasia in the head and neck region is recognized to be a precancerous lesion. Between January 1983 and December 1987, a pilot study was conducted at the Manitoba Cancer Treatment and Research Foundation to determine the effects of beta-carotene and cis-retinoic acid on mucosal dysplasias. Eighteen patients were treated with a "cross-over" regimen. The overall response to treatment was 61%, with 33.3% complete responses. Patients who smoked had a significantly better response than nonsmokers. The response rate for 9 of 11 smokers was 81.2%, and 2 of 7 nonsmokers or 28.6% responded to this protocol. The beneficial effect of these drugs should be established by prospective, randomized trial in high risk populations.

Topics: Adult; Aged; Aged, 80 and over; beta Carotene; Carotenoids; Drug Evaluation; Erythroplasia; Female; Humans; Leukoplakia, Oral; Lichen Planus; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Pilot Projects; Precancerous Conditions; Prospective Studies; Smoking; Tretinoin; Vitamin A

Sixty-five patients with lichen planus were included in a multicenter trial of acitretin. At the end of an 8-week placebo-controlled, double-blind phase, a significantly higher number of patients treated with 30 mg/day acitretin (64%) showed remission or marked improvement compared with placebo (13%). Furthermore, during the subsequent 8-week open phase, 83% of previously placebo-treated patients responded favorably to acitretin therapy. Typical retinoid adverse reactions were present in all patients on active drug. Laboratory studies did not show any clinically significant changes. This study shows that acitretin is an effective and acceptable therapy for severe cases of lichen planus.

Topics: Acitretin; Adult; Aged; Aged, 80 and over; Double-Blind Method; Female; Humans; Lichen Planus; Male; Middle Aged; Tretinoin

Twenty patients with oral lichen planus (OLP) were divided into two groups. The first group (8 reticulated OLP, 2 hyperkeratotic OLP) was treated with topical tretinoin. The second group (4 reticulated OLP, 6 eroding OLP) was treated with oral etretinate. All patients were regularly followed in order to observe over a period of five years the evolution of the lesions under treatment, the side-effects and recurrences when the treatment was discontinued.

Topics: Adult; Aged; Aged, 80 and over; Etretinate; Female; Humans; Lichen Planus; Male; Middle Aged; Mouth Diseases; Recurrence; Tretinoin

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

A double-blind study of twenty-eight patients with severe oral lichen planus treated with etretinate (75 mg daily) or a placebo for 2 months, showed that the oral retinoid had a marked beneficial effect. Nine non-responders who had received only placebo then entered an open cross-over study and they responded well to etretinate. Etretinate thus provided effective symptomatic relief for severe oral lichen planus, but side-effects were common, and six patients stopped treatment because of them.

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

Experiences in the treatment of lichen planus mucosae (including the erosive type) are reported. Good therapeutical results could be obtained in all patients. Leukoplakic patches showed a partial involution and in some cases erosive alterations healed completely. After interruption of medication a relapse was observed in most cases. Concerning side effects, some patients complained in particular of minor dryness of both labial and nasal mucosa and of diffuse hair effluvium.

Topics: Adult; Aged; Clinical Trials as Topic; Drug Evaluation; Etretinate; Female; Humans; Leukoplakia, Oral; Lichen Planus; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Recurrence; Time Factors; Tretinoin

The treatment of severe forms of oral lichen planus is still relatively unsatisfactory. In this controlled study, 0.1% tretinoin in an adhesive base was used in 23 patients. Fifteen other control patients were similarly treated with the vehicle alone. In the tretinoin-treated group, 71% of the atrophic-erosive lesions improved while 29% improved from the vehicle (P less than .05). Reticular-plaque lesions improved in 74% from tretinoin and in 15% from the vehicle (P less than .001). Irritation from tretinoin occurs and thorough usage information is mandatory.

Topics: Administration, Topical; Adult; Aged; Cheek; Female; Humans; Lichen Planus; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Tretinoin; Vitamin A

Topics: Clinical Trials as Topic; Drug Evaluation; Female; Humans; Lichen Planus; Male; Tretinoin; Vitamin A

Topics: Administration, Oral; Adult; Alitretinoin; Antineoplastic Agents; Female; Humans; Lichen Planus; Male; Middle Aged; Nail Diseases; Nails; Retinoid X Receptors; Tretinoin

Topics: Administration, Oral; Aged; Alitretinoin; Antineoplastic Agents; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Lichen Planus; Middle Aged; Severity of Illness Index; Treatment Outcome; Tretinoin

Topics: Adult; Alitretinoin; Humans; Lichen Planus; Male; Nail Diseases; Treatment Outcome; Tretinoin

Topics: Administration, Oral; Alitretinoin; Anti-Inflammatory Agents; Drug Therapy, Combination; Female; Humans; Lichen Planus; Male; Middle Aged; Skin; Time Factors; Treatment Outcome; Tretinoin

Topics: Adhesives; Administration, Cutaneous; Child; Gels; Humans; Keratolytic Agents; Lichen Planus; Male; Treatment Outcome; Tretinoin

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

Retinoids were shown to be effective in the treatment of both oral and cutaneous forms of lichen planus.. Confirm the beneficial effect of low doses of oral tretinoin in lichen planus.. Eighteen patients with lichen planus were treated in an open study for up to 19 months. Efficacy and safety data were recorded.. Complete remission was observed in 13 (72%) and marked improvement in 4 (22%) out of 18 patients. Six patients showed moderate and 12 had no side effects.. Tretinoin is a valuable drug when given at low doses to patients with lichen planus who failed to respond to other therapies.

Topics: Administration, Oral; Adult; Aged; Female; Humans; Keratolytic Agents; Lichen Planus; Male; Middle Aged; Tretinoin

Topics: Acitretin; Adult; Female; Humans; Lichen Planus; Male; Tretinoin

In order to study the elimination of Ro 10-1670 (acitretin) and Ro 13-7652, its 13-cis-isomeric metabolite after chronic administration, determination of the residual plasma concentrations of these two compounds were assayed in 9 patients in a range of 22-30 days following cessation of a 2- to 7.5-month course with daily oral doses of 10-50 mg of acitretin. A highly sensitive HPLC method was used (2 ng/ml). Residual plasma concentrations of Ro 10-1670 were below the quantification limit in all cases. Residual plasma concentrations of Ro 13-7652 were below the quantification limit in 7 cases and respectively of 3 and 4 ng/ml in the other 2 cases. These data appear to confirm the absence of storage of acitretin even after an extended course of therapy.

Topics: Acitretin; Adolescent; Adult; Aged; Chromatography, High Pressure Liquid; Female; Humans; Lichen Planus; Male; Middle Aged; Psoriasis; Tretinoin

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

A 34-year-old female patient presented with the classical features of keratosis lichenoides chronica, a very rare dermatosis. Typical hyperkeratotic papules in a linear and reticular pattern were located on the upper extremities and the trunk. The nails and the perionychial areas showed marked vegetating lesions. After administration of a combined retinoid-PUVA therapy impressive remission was observed. The clinical picture, the differential diagnosis, in particular from lichen ruber planus, and the therapeutic aspects are discussed.

Topics: Administration, Oral; Administration, Topical; Adult; Chronic Disease; Combined Modality Therapy; Etretinate; Female; Humans; Lichen Planus; PUVA Therapy; Skin; 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

Topics: Adult; Aged; Female; Humans; Lichen Planus; Male; Middle Aged; Mouth Diseases; Tretinoin

In 4 patients with lichen planus mucosae (l.p.m.) biopsies were taken from the involved and uninvolved buccal sides before treatment and from the affected side after a 3-week systemic therapy with aromatic retinoid (Ro 10-9359; 50 mg/die). After in vitro labelling with 3H-thymidine the epithelial cell proliferation was determined histo-autoradiographically. In atrophic lesions of l.p.m., increased 3H-thymidine labelling indices were observed during retinoid therapy. After 3 weeks of treatment the augmented relative portion of labelled basal cells (quotient LIbas/LIsuprabas) was found to be lowered, indicating a tendency of proliferating cells to regain normal distribution in the progenitor compartment of the mucosa epithelium.

Topics: Adult; Aerosols; Autoradiography; Biopsy; Cell Division; Cheek; Etretinate; Female; Humans; Lichen Planus; Male; Middle Aged; Mouth Mucosa; Thymidine; Tretinoin; Tritium

Twenty-five patients with chronic oral lichen planus, usually of the atrophic-erosive type, were treated for 2 months with Etretinate 0.6 mg/kg b.w./day, followed for 4 months by Etretinate 0.3 mg/kg/day, or 0.1% Tretinoin in an adhesive base. Complete resolution or improvement was seen in 85% of the lesions after first treatment. The number of patients with oral soreness and pain was significantly reduced (p less than 0.001). During the second treatment, the improvement was maintained or even increased in about 70% of the patients, irrespective of the mode of treatment. Treatment was discontinued in one patient owing to moderately increased serum transaminase levels. The number of drug-related drop-outs was significantly lower than in a previous study utilizing an etretinate dose of about 1 mg/kg/day (p less than 0.05). Other adverse effects were minor and tolerable. Retinoids offer an effective mode of therapy for severe oral lichen planus.

Topics: Adult; Aged; Drug Evaluation; Drug Therapy, Combination; Etretinate; Female; Humans; Lichen Planus; Male; Middle Aged; Mouth Diseases; Recurrence; Tretinoin

A novel mucosal adhesive ointment on the base of partly neutralized polymethacrylic acid methyl ester (Eudispert) was formulated. The flow curves of the ointment show a pseudoplastic quality without any thixotropic effect. The viscosity depended on the kind and concentration of the base. During the clinical studies the pure ointment as well as a tretinoin-preparation for a lichen planus treatment showed no local irritation, good mucosal adhesion and suitable way of application for the patients.

Topics: Acrylic Resins; Adhesiveness; Drug Hypersensitivity; Humans; Lichen Planus; Mucous Membrane; Ointments; Polymethacrylic Acids; Skin Tests; Tretinoin

Retinoids are used in the treatment of lichen planus (LP) disease, but their mechanism of action remains unknown. We studied the epidermal Langerhans' cells in four patients with chronic LP, before and after treatment with aromatic retinoids. This study uses a new technique of quantification and exploits two monoclonal antibodies-OKT 6 specific for Langerhans' cells and BL 2 specific for HLA-DR antigens. Our results show an increase in the number of dendritic epidermal cells after treatment with oral retinoids. The number of OKT 6-positive cells is greater than the number of BL 2-positive (HLA-DR) cells before and after treatment.

Topics: Adolescent; Adult; Antibodies, Monoclonal; Etretinate; Humans; Langerhans Cells; Lichen Planus; Male; Tretinoin

This study reports comparative results of the effects of an aromatic retinoid, etretinate (RO 10-9359), on various disorders of the skin and mucous membranes. One hundred thirteen patients suffering from psoriasis, lichen planus, keratosis follicularis, and various other disorders were treated and examined. The patients received 25 to 100 mg/day of oral etretinate for up to 30 months. Patients with erythrodermic psoriasis, pustular psoriasis, and keratosis follicularis showed the best response. The conditions of patients with psoriasis vulgaris, palmoplantar psoriasis, and lichen planus also improved, but less impressively. The mucous membrane lesions of lichen planus and leukoplakia showed only moderate improvement. The most striking adverse clinical reactions observed were cheilitis (70%), dryness of the mucous membranes (27%), and hair loss (27%).

Topics: Administration, Oral; Adolescent; Adult; Darier Disease; Etretinate; Female; Humans; Lichen Planus; Male; Middle Aged; Mucous Membrane; Psoriasis; Skin Diseases; Tretinoin

Therapeutic benefits from aromatic retinoid have been described in the treatment of a variety of dermatological disorders. Stress is given on some of them which coexist with ungual abnormalities and the results are reported. These diseases include psoriasis, acropustulosis, keratosis lichenoides chronica. Drug-induced modifications of the epidermal structures of the nail apparatus are emphasized: fragility with onychorrhexis and onychoschizia is the commonest finding. Onychomadesis and nail shedding can be seen. Onycholysis is rare. Painful paronychia which is sometimes accompanied by granulation tissue and ingrowing nails is the most interesting alteration due to this synthetic retinoid and as yet unexplained.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Etretinate; Female; Humans; Keratosis; Lichen Planus; Male; Middle Aged; Nails; Nails, Malformed; Psoriasis; Tretinoin

Topics: Administration, Oral; Adult; Cell Count; Eczema; Epidermis; Etretinate; Female; Humans; Langerhans Cells; Lichen Planus; Male; Middle Aged; Psoriasis; Skin Diseases; Tretinoin

Topics: Administration, Topical; Adult; Aged; Female; Humans; Leukoplakia, Oral; Lichen Planus; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Recurrence; Tretinoin

Diffuse lichen planus, a rare disorder in children, was observed in an 8-year-old boy. Effective therapy in this disease remains a problem and currently relies predominantly on the use of the corticosteroids. The complications attendant with corticosteroid administration in children are discussed and a review of alternate modes of therapy for lichen planus is presented.

Topics: Adrenal Cortex Hormones; Adrenal Insufficiency; Child; Griseofulvin; Growth Disorders; Humans; Lichen Planus; Male; Pruritus; PUVA Therapy; Tretinoin; Vitamin A

24 patients suffering from generalized lichen planus were treated systemically with a aromatic retinoid (RO 10-9359). Initially a dose of 100 mg retinoid per day was administered for 2 to 3 weeks, then the daily intake was reduced slowly. The average duration of treatment was 72 days. This therapy produced a significant improvement in all patients. Lesions recurred during reduction of administered retinoid in 3 patients and after stopping treatment in 5 cases. Initially side effects consisted of cheilitis and exfoliation of the skin over the palmar and plantar regions; later 50% of the patients developed an effluvium. The results of the present study indicate that the aromatic retinoid can be considered as an alternative drug to systemic steroids in the treatment of lichen planus.

Topics: Dose-Response Relationship, Drug; Female; Humans; Lichen Planus; Male; Tretinoin; Vitamin A

Topics: Adolescent; Aged; Anti-Bacterial Agents; Child; Cryosurgery; Darier Disease; Elastic Tissue; Epidermolysis Bullosa; Female; Humans; Impetigo; Larva Migrans; Lichen Planus; Male; Middle Aged; Papilloma; Pemphigus; Skin Diseases; Tongue Neoplasms; Tretinoin

27 patients with lichen planus mucosae or erosive lichen planus mucosae were treated with two vitamin A acid derivatives, 13-cis-retinoic acid or an aroumatic retinoid. 20 patients were definitively improved or healed. The treatment was especially effective in erosive lesions of the oral mucous membrane. Side-effects of this treatment are pointed out.

Topics: Adult; Aged; Humans; Lichen Planus; Middle Aged; Mouth Mucosa; Tretinoin; Vitamin A

Up to date, the treatment of palmar/plantar hyperkeratoses presents a therapeutic problem. The known therapeutic procedures result in short-term improvement only, if any at all. In these investigations involving 68 patients suffering from palmar/plantar hyperkeratoses of different etiology, small doses of vitamin A acid locally applied, produced a striking improvement in hypertrophic lichen planus of palms or soles: the regression was complete and in most cases permanent. The skin texture of patients with genetic keratoses and callosities became normal within a few weeks: but this condition remained free of symptoms only as long as vitamin A acid was used as a maintenance dose once or twice weekly. In hyperkeratotic eczema, pityriasis rubra pilaris, and verrucae plantaris vitamin A acid locally applied was found to be unsuitable for treatment. The possible side effects of this treatment are mentioned. Several possibilities regarding the way of action of vitamin A acid are discussed.

Topics: Callosities; Eczema; Humans; Keratoderma, Palmoplantar; Lichen Planus; Long-Term Care; Occlusive Dressings; Ointments; Pityriasis Rubra Pilaris; Tretinoin; Vitamin A; Vitamin A Deficiency; Warts

98 patients, 50 suffering from papular lichen planus of the skin, 48 suffering from hypertrophic lichen planus, were treated systemically or topically with vitamin A acid. In 52 out of the 98 patients, the treatment was started within the first 3 months after the beginning of the disease. The patients with papular lichen planus improved rapidly to systemic vitamin A acid administration. In hypertrophic lichen planus only topical vitamin A acid application showed satisfactory results. The possible side effects of this treatment are mentioned. Patients with disturbed hepatocellular of hepatocystic conditions are unsuitable for vitamin A acid therapy.

Topics: Administration, Oral; Administration, Topical; Adult; Aged; Female; Humans; Lichen Planus; Long-Term Care; Middle Aged; Tretinoin; Vitamin A