Oral, topical combination outperforms topical monotherapy for oral lichen planus treatment

Key takeaways:

• At week 28, 88% of patients treated with combination therapy achieved 75% disease severity reduction vs. 47% on monotherapy.
• At week 36, 84% vs. 41% saw a 75% reduction in disease severity.

Acitretin in combination with topical triamcinolone acetonide 0.1% may be a better treatment option than triamcinolone acetonide alone for patients with oral lichen planus, according to a study.

“Lichen planus is a chronic inflammatory mucocutaneous disease associated with a T-cell-mediated cytotoxic response and an interferon-gamma signature,” Keshavamurthy Vinay, MD, DNB, of the department of dermatology, venereology and leprology at the Postgraduate Institute of Medical Education and Research in Chandigarh, India, and colleagues wrote. “The oral mucosa is a commonly involved site, followed by skin, genitalia, scalp and nails.”

When the oral mucosa is involved, this disease is called oral lichen planus (OLP). To evaluate the best treatment options for this condition, the authors conducted a placebo-controlled, double-blinded study.

In the study, 64 patients aged 18 years or older with symptomatic OLP were randomly assigned to receive either a combination of 25 mg to 35 mg of daily oral acitretin and triamcinolone acetonide (TAC) 0.1% or TAC monotherapy. Thirty-one patients completed the study in the treatment group and 30 completed the study in the placebo group.

Results showed that a higher proportion of patients in the combination group achieved a 75% or higher reduction in Oral Disease Severity Score (ODSS) compared with the monotherapy group at the end of 28 weeks (28; 88% vs. 15; 47%; P < .001) and 36 weeks (27; 84% vs. 13; 41%; P < .001).

Eight weeks after treatment, relapse rates were similarly low between groups (1 vs. 2).

“Acitretin in combination with topical TAC was more efficacious in the treatment of OLP than topical TAC alone,” the authors concluded. “This combination should thus be considered as a treatment option in symptomatic disease or in patients who are not responding adequately to topical treatments alone.”