Lichen planus glucocorticoids

A 75-year-old woman was given hydroxychloroquine 400 mg/day for erosive lichen planus in conjunction with topical glucocorticoids and a short course of oral methylprednisolone 0.5 mg/kg/day. After 10 days she became disoriented in time and place, followed by feelings of depersonalization and kinesthetic hallucinations, preceded by nightmares. She stopped taking hydroxychloroquine 1 week later and the hallucinations progressively disappeared. She recovered her normal mental state within 1 month and had not relapsed 2 years later. 

A 56-year-old Nigerian woman, with a previous history of sickle cell trait, osteoarthritis, and non-insulin-dependent diabetes mellitus, took amlodipine 5 mg/day for hypertension for 2 weeks and developed a lichenoid eruption (15). Histological examination confirmed the diagnosis of lichen planus. Amlodipine was withdrawn and there was rapid symptomatic and clinical improvement after treatment with glucocorticoids and antihistamines. 

In 1990, etretinate (Tigason) was replaced by acitretin (Neo-Tigason), an aromatic retinoid, a carboxylic acid metabolite of etretinate (15). It is effective in pustular psoriasis and psoriatic palmoplantar keratoderma and in combination with PUVA or topical therapy (calci-potriol or glucocorticoids) in the treatment of other forms of psoriasis. It has also been used to treat disorders of keratinization (ichthyosis, palmoplantar keratoderma, Darier s disease) and severe cutaneous forms of lichen planus. It prevents new skin carcinomas in patients with xeroderma pigmentosum and those who are immunosuppressed. The main advantage of acitretin is its short half-life of 50 hours, compared with over 80 days for etretinate (16). 

The onset in this case was during the administration of triamcinolone for alopecia areata. Although glucocorticoids have not been previously reported to have caused lichen planus, the possibility that triamcinolone might have affected the immune system caimot be excluded. 

---

See also in sourсe #XX -- [ ]

---