Low-dose low-molecular-weight heparin (enoxaparin) is beneficial in lichen planus: a preliminary report (original) (raw)
1998, Journal of The American Academy of Dermatology
Background: Low-dose heparin devoid of anticoagulant activity inhibits T-lymphocyte heparanase activity, which is crucial in T-cell migration to target tissues. Objective: The purpose of this study was to assess the efficacy of low-dose enoxaparin (Clexane), a low-molecular-weight heparin, as monotherapy in lichen planus. Methods: Included in the study were 10 patients with widespread histopathologically proven lichen planus (LP) associated with
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IP Innovative Publication Pvt. Ltd., 2017
Lichen planus (LP) is a T cell mediated disorder(6) that affects the skin and mucosa, exhibiting distinct morphologic and histopathological features. (10) The term Lichen is derived from Greek word (Leichen), (6) which means tree moss. (20) It is a self-limiting disease that affects mostly middle-aged people. (13) It can involve the skin, mucous membrane, hair and nails. (6) Oral lichen planus(38) can occur with or without skin lesions. The typical lesion of lichen planus is pruritic, polygonal, faintly erythematous to violaceous flat topped papule distributed over the flexors. Other morphological types(9) include hypertrophic, atrophic, vesicular and bullous lesions. (13) Koebner‘s phenomenon may be seen. Many causes have been implicated. Although spontaneous regression can occur in a few patients itching can be very troublesome. Various treatment options are available in the form of topical(48) and systemic therapy. (46,47) Low dose of low molecular weight heparin (Enoxaparin) was first used by Hodak et al(1) in 1988 at the dose of 3 mg in the treatment of lichen planus. Enoxaparin(7) is a disaccharide(43) moiety derived from heparin by a method of polymerization. (37) Unlike heparin it is devoid of anticoagulant property. Its immunomodulatory(42) and anti proliferative properties enables its use in lichen planus. Enoxaparin(19) inhibits the expression of heparanase enzyme (endoglycosidase) that is synthesized by CD4 cells. T lymphocytes heparanase(44) cleaves the heparin sulfate side chains of the extracellular matrix allowing the T cell to penetrate into subendothelial(47) basal lamina of the epidermis to reach the target tissues. Enoxaparin also inhibits delayed type hypersensitivity response. (33,39) It also acts by inhibiting the key pro- inflammatory cytokine tumour necrosis factor alpha. (36,21) Its anti-pruritic effect(33) is evident within a week of onset of the treatment. In our study Enoxaparin was given at a dose of 4mg subcutaneously every week to 100 patients for 9 weeks and the reduction in ISS was determined. The percentage of reduction was also analysed.
Innovative Publication, 2016
Background: Lichen planus is a difficult condition to treat and is often disappointing for dermatologist. Many a times it's associated with relapse. There is long list of topical & systemic therapies for its treatment. Aim & Objectives: the objective of this study was to compare the efficacy and safety of methotrexate and low molecular weight heparin in generalized lichen planus patients along with 6 months follow up. In this study 40 patients with generalized lichen planus were enrolled after basic evaluation 20 patients(11 males, 9 females) were started on low dose methotrexate & 20 patients(11 males, 9 females) on low molecular weight heparin. The response rate were appraised after once a week for 16 to 24 weeks for both methotrexate & low molecular weight heparin. Six month follow up was done for evaluating the recurrence rate. At the end of 16 to 24 weeks of treatment with methotrexate 19 of 20 patients showed 90% improvement, 1 patient did not tolerate methotrexate after 4 weeks because of its adverse effects. Only 3 patients were showed relapse after discontinuation of therapy at 3, 2.6, 2 months respectively. At the end of 16 to 24 weeks of treatment with low molecular weight heparin complete remission of skin lesions in 13 of 20 patients with 80% improvement. Also 7 patients showed relapse after discontinuation of therapy at 2, 3, 3.6, 1.6, 4, 2, 6 months respectively. Conclusion: Overall we want to emphasized that low dose oral methotrexate is effective & is a reasonably safe option for generalized LP. There was better tolerance by patients with low recurrence rate than subcutaneous low molecular weight heparin.
Journal of the European Academy of Dermatology and Venereology, 2020
Lichen planus (LP) is a chronic inflammatory and immune‐mediated disease that affects the skin, hair, nails and mucous membranes. Although there is a broad clinical spectrum of lichen planus manifestations, the skin and oral cavity remain the major sites of involvement. A group of European dermatologists with a long‐standing interest and expertise in lichen planus has sought to define therapeutic guidelines for the management of patients with LP. The clinical features, diagnosis and possible medications that clinicians can use, in order to control the disease, will be reviewed in this manuscript. The revised final version of the lichen planus guideline was passed on to the European Dermatology Forum (EDF) for a final consensus with the European Academy of Dermatology and Venereology (EADV).
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