Safety and efficacy of hydroxychloroquine in patients of symptomatic oral lichen planus
Keywords:
Oral lichen planus, hydroxychloroquine, anti-malarialsAbstract
Background A wide variety of therapies have been used to treat symptomatic oral lichen planus (OLP). Role of anti-malarial agents in oral lichen planus is not fully studied. Aim To evaluate safety and efficacy of hydroxychloroquine in the treatment of symptomatic OLP. Methods Thirty seven patients with symptomatic OLP were included in the study. Patients were started on tablet hydroxychloroquine 200 mg twice daily and continued for a period of 6 months. Clinical evaluation was performed at the beginning of the treatment and then every 2 months during 6-month period of active treatment and thereafter again after 6 months of follow-up. Pain and clinical evaluation were done using visual analogue scale (VAS) and Thongprasom scale. Results Thirty-seven patients were included; however, 7 patients were lost to follow-up, and excluded from final analysis. At the time of completion of therapy, 80% of the patients had no lesions. There was no recurrence until 6 months after completion of therapy. Gastritis was the most common adverse event. There were no other serious adverse events. Conclusion Hydroxychloroquine is the effective and safe treatment for symptomatic OLP.References
Wee JS, Shirlaw PJ, Challacombe SJ, Setterfield JF. Efficacy of mycophenolate mofetil in severe mucocutaneous lichen planus: a retrospective review of 10 patients. Br J Dermatol 2012;167:36–43
Lodi G, Scully C, Carrozzo M, Griffiths M, et al. Current controversies in oral lichen planus: report of an international consensus meeting. Part 2.Clinical management and malignant transformation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:164–78
Eisen D. Hydroxychloroquine sulfate (Plaquenil) improves oral lichen planus: an open trial. J Am Acad Dermatol 1993;28:609–12
De Argila D, Gonzalo A, Pimentel J, Rovira I. Isolated lichen planus of the lip successfully treated with chloroquine phosphate Dermatology 1997; 195:284-5.
Bhuiyan I, Wahab MA, Ali A, Sultana A, et al. Comparative efficacy of hydroxychloroquine and griseofulvin in the treatment of lichen planus. J Pak Assoc Dermatol 2010; 20:79-83.
Zhu Y, Li J, Bai Y, Wang X, Duan N, Jiang H, et al. Hydroxychloroquine decreases the upregulated frequencies of Tregs in patients with oral lichen planus. Clin Oral Investig 2014; 18:1903-11.
Tolosa NR, Requena C, Llombart B, Alcala R, Serra-Guillen C, Calomarde L, et al. Antimalarial drugs for the treatment of oral erosive lichen planus. Dermatology 2016;232:86–90
Munde AD, Karle RR, Wankhede PK, Shaikh SS, et al. Demographic and clinical profile of oral lichen planus: A retrospective study. Contemp Clin Dent. 2013;4:181-5
Rivas-Tolosa N, Requena C, Llombart B, Alcalá R, et al: Antimalarial Drugs for the Treatment of Oral Erosive Lichen Planus. Dermatology 2016;232:86-90
Bondeson J, Sundler R: Antimalarial drugs inhibit phospholipase A2 activation and induction of interleukin 1beta and tumor necrosis factor alpha in macrophages: implications for their mode of action in rheumatoid arthritis. Gen Pharmacol 1998;30:357-366
Pallerla SR, Badam RK, Boringi M, Pacha VB. Hydroxychloroquin: A new hope in the management of oral lichen planus. J Indian Acad Oral Med Radiol 2015;27:572-5
Rodriguez-Caruncho C, BielsaMarsol I. Antimalarials in dermatology. Mechanism of action, indications, and side effects. Actas Dermosifiliogr 2014; 105:243–252.
Wolfe F, Marmor MF: Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res 2010;62:775-784
Jewell ML, McCauliffe DP: Patients with cutaneous lupus erythematosus who smoke are less responsive to antimalarial treatment. J Am Acad Dermatol 2000;42:983-987
Piette EW, Foering KP, Chang AY, Okawa J, et al: Impact of smoking in cutaneous lupus erythematosus. Arch Dermatol 2012;148:317-322
