How Do I Choose the Best Lichen Planus Treatment?

Mucosa lichen planus is a chronic or subacute inflammatory skin disease that mainly affects the oral and genital mucosa for unknown reasons. Histopathological examination is characteristic. The course of the disease is months to years and is self-limiting. ^[1]

Lichen planus

Basic overview of mucosal lichen planus

Pathogenesis of mucosal lichen planus

Causes of Mucosa Lichen Planus

The cause is unknown. Factors related to the onset include heredity, autoimmunity, infection, mental and neurological dysfunction, drugs, chronic lesions, metabolic and endocrine diseases. 10.7% of patients had a family history, and the positive rates of HLA-A3, A5, B7, B8, BW35, HLA-DR1, and HLA-DQ1 antigens were significantly higher than those of the normal population. Many studies have confirmed that this disease may be a cell-mediated autoimmune disease, and activated T cells may play an important role in the occurrence of this disease. Direct immunofluorescence examination revealed the deposition of immunoglobulins and complements at the epidermal and dermal junctions of the lesions, and lichen planus-specific antigens in the granular or spinous layers. Corresponding antibodies can also be detected in the serum.

Mucosal lichen planus

Excessive keratinization, thickening of the granular layer, irregular thickening of the spinous layer, liquefaction and degeneration of basal cells, and mononuclear cells in the upper layer of the dermis infiltrate in a band. ^[1]

Clinical manifestations of lichen planus

Occurs in middle-aged people, more women. The buccal mucosal damage was the most common, followed by the back of the tongue, gums, lips, glans, labia, anus, etc., without obvious symptoms. The buccal mucosa is from the depth of the dentition to the corner of the mouth, and is characterized by milky white thin lines, 1 ~ 2mm wide, which is often distorted into a mesh, dendritic, or short cord. Sometimes the red lines around the white lines are accompanied by a bleeding face. Often occurs symmetrically. The white lines are keratotic lesions, which look like Candida pseudomembrane, but they are not easy to peel off with pincers. The back of the tongue is usually white-spotted, large in size, like soybeans, sometimes depressed in the center, and raised around. In addition to the reticular white stripes on the gums, atrophic lesions can be seen, and the gums are red. Oral lichen planus usually does not develop ulcers. If you see ulcers, you should think of malignancy. The skin and fingernails can be affected at the same time. ^[1]

Mucosal lichen planus diagnostic criteria

Clinically, milky white reticular stripes are visible on the buccal mucosa, invasive white spots on the back of the tongue, and polygonal, flat papules on the skin. It is not difficult to diagnose with histopathological changes. Should be distinguished from oral candidiasis and mucosal leukoplakia. ^[1]

Treatment of Mucosa Lichen Planus

There are no specific therapies. It is far more difficult to treat oral damage than skin damage. At present, the following methods are mainly used.

General treatment of mucosa lichen planus

Eliminate or reduce mental stress, treat chronic lesions, and avoid factors that are likely to cause tissue damage, such as tobacco and alcohol, irritating diets, sharp or rough teeth or trays, and inappropriate mouth appliances, etc. Drugs, such as streptomycin, gold, arsenic, etc.

Local treatment of mucous lichen planus

(1) Glucocorticoids, all kinds of high-efficiency glucocorticoid preparations suitable for mucosal use can be applied externally. Cortisone suppositories are effective for vaginal or rectal damage.

(2) Vitamin A acid preparation. For oral damage, 13-cis-A acid gel hydrogen peroxide (0.1%) can be used to gargle. There may be mild irritation and a short burning sensation in the local area.

(3) Those who have erosive face can use chlorhexidine, benzocaine, cyclosporine, dobe solution, 1: 5000 furacicin, and betamethasone valerate to gargle.

(4) External use of 1% chlortetracycline and glycerol plus prednisone, or golden times paste (containing chlortetracycline 250mg, betamethasone 1.5mg, glycerol 10ml) has a good effect on chronic lesions.

(5) Cyclosporine, oral gargle, 1 ~ 5ml per day, containing 100mg per ml, effective for oral lesions.

(6) tacrolimus, topical topical treatment of stubborn ulcerative oral mucosa lichen planus.

(7) Partially closed. The base of the lesion was treated with hydrocortisone 0.5ml plus 2% procaine 0.5ml once a day, or vitamin B12100g plus 2% procaine 1ml, once or twice a week, local injection. Ferguson reports 5 cases of oral lichen planus, which were injected with methylprednisolone 0.5 ~ 1ml submucosally (40mg / ml), and all had good results after 48h.

(8) Physical therapy. Liquid nitrogen freezing has a good effect on oral lichen planus, and the damage often heals within 3 weeks, and histology returns to normal after 4 weeks. CO2 laser is effective in treating oral erosive lichen planus, and the mucosal epithelium can be regenerated after 4 ~ 6 weeks.

Mucosal Lichen Planus Systemic Therapy

Drugs that work on lichen planus are also effective on mucosal lesions.

(1) Glucocorticoid: It is currently the most important drug for the treatment of this disease. Prednisone 20 ~ 40mg / d, taken orally in 2 or 3 times for 6 weeks, and then reduced in the next 6 weeks, and discontinued after 3 months. For stubborn cases, shock therapy is available.

(2) Retinoic acid: It has the best effect on pimples-type lichen planus. Generally use Avitamin A or Isotretinoin, 30-40mg / d, orally in divided doses, and even take it for 3 weeks. If there is no effect, stop using it. Retinoic acid has certain adverse reactions, such as elevated transaminase, urea nitrogen, increased blood lipids, and dry mucous membranes.

(3) Chloroquine phosphate or hydroxychloroquine sulfate: 250mg of chloroquine phosphate twice daily, and then changed to 250mg / d after 2 weeks, even for 3 months. Hydroxychloroquine sulfate 200 ~ 400mg / d, the course of treatment is 6 months.

(4) Isoniazid: 300 ~ 400mg / d for adults, less for children.

(5) dapsone: 50 ~ 100mg / d.

(6) Metronidazole: 200mg, 3 times a day, 2 weeks as a course of treatment, if 3 courses of treatment are not effective, discontinue.

(7) Griseofulvin: 500mg daily, effective within 2 weeks, can be applied continuously for 3 to 6 months.

(8) Phenytoin sodium: 100 ~ 200mg / d, taken orally in divided doses, usually with effect within 2 ~ 8 weeks.

(9) Immunosuppressants: Cyclosporine, 3-6 mg / kg daily, orally, usually effective within 2 to 4 weeks. Mycophenolate mofetil, 1g, 2 times a day, effective for 5 to 6 weeks, the course of treatment is about 20 weeks. Others can also use azathioprine 25mg, twice a day; cyclophosphamide 25 ~ 50mg, twice a day, orally; or triptolide 0.5 ~ 1mg / kg, divided orally, can be used for general refractory cases .

(10) Immunomodulator: levamisole 50 mg, 3 times a day, 2 days a week, orally, 2 months as a course of treatment. Lipopolysaccharide 0.5 ~ 1mg, intramuscular injection, once a day, 20 times as a course of treatment. Polymyocyte 2mg, intramuscular injection, twice a week, 4 times a course of treatment. Transfer factor 2 ~ 4ml, subcutaneous injection, 1 or 2 times a week, 10 times as a course of treatment.

Mucous lichen planus, chinese medicine, chinese medicine

Some people divide the disease into two large and small ones, and think that the deficiency syndrome is mostly liver and kidney yin deficiency, and the evidence is mainly based on liver qi stagnation or liver meridian. Reticulated plaque syndrome is due to lack of yin and blood, blood deficiency and dryness, and should be treated with nourishing yin and nourishing blood, and dredging wind and dryness. Fang uses raw land, wolfberry, angelica, schisandra, asparagus, cypress, almond, codonopsis, poria, salvia, white fresh skin, polygala, etc., decoction. Plaque atrophy type is liver stagnation and fire, qi stagnation and blood stasis, Zhiping Pinggan heat and blood circulation. Recipes include raw land, Scutellaria baicalensis, Shuanghua, Guiwei, Danpi, Salvia miltiorrhiza, Cimicifuga, Catechu, Baiji and so on. Congestion and erosion syndrome is a kind of damp heat, qi and blood block or blood deficiency of yin deficiency. The prescription uses raw land, gypsum, paeonia glutinosa, scutellaria baicalensis, Coptis chinensis, Cimicifuga, catechu, Shuanghua, Paeonia lactiflora, Salvia miltiorrhiza, Guiwei, Jiao Sanxian, etc., plus detoxifying Shengji powder.

Huang Yazhang uses salvia miltiorrhiza, Chuanxiong, Heterophyllum, Yujin, etc. to make 1000-coated sugar-coated tablets to treat 60 cases of oral lesions, 3 times a day, after meals, 2 months as a course of treatment, after 1 to 6 courses, there are The efficiency is 78.3%.

Wuwei Disinfecting Drink Helongdan Xiegan Decoction Addition and Subtraction, 30g silver flower, 10g forsythia, 30g of yingying, 10g of diced chrysanthemum, 30g of wild chrysanthemum, 12g of bile, 12g of artemisia annua, 6g of pistacia, 6g of plantain Dan bark 12g, atractylodes 15g, black ginseng 12g, Ophiopogon 15g, raw licorice 12g, 10d is a course of treatment.