On treatment of atypical lichen planus of skin and oral cavity

Relevance. Lichen planus (LP) is a chronic inflammatory disease with an unknown etiology and pathogenesis. Some authors associate frequent resistance of oral LP (OLP) to the methods, successfully used in treatment of LP of the skin with a separate immunopathological mechanisms and the corresponding epithelial-cell reactions. On this account we have used effective and pathogenetically substantiated method of complex treatment of LP of the skin with the use of extracorporeal photochemotherapy (ECP) and routine therapy (delagil, doxycycline, vitamin B 6, applications of corticosteroid ointments), and for increasing of efficiency of complex treatment with the use of ECP in erosive and other forms of OLP in conjunction with the atypical skin lesions we used methotrexate in combination with ECP and routine therapy. Goal. Research of a clinical efficacy and pathogenetic orientation of the complex therapy with ECP and methotrexate of atypical LP of the skin in combination with OLP lesions. Material and methods. We conducted a study of clinical efficacy of complex treatment with the use of routine therapy, ECP and methotrexate in 18 patients with atypical LP of the skin with lesions in the oral cavity. The EPC method included isolation of mononuclear cells preliminary sensitized with 8-methoxypsoralen with a cell separator Haemonetics MCS+. After the cell suspension was treated with UV А (X = 320-400 nm), it was re-infused to the patient. The treatment course included 4 sessions performed every other day. A single injection of methotrexate was performed in the middle of the course at a dose of 10.0 mg. The severity of lesions in the oral cavity was evaluated with a scale of Thongprasom, subjective feelings of the patient- using a visual analogue scale (VAS). Results. Fll patients tolerated treatment satisfactorily, without complications and side effects. After the treatment all patients noted disappearance of itching on the skin, in 83.4 % of cases was received a complete regression of the lesions. In relation to the lesions on the oral cavity, all patients reported resolution of pain, which was reflected on VAS scale, and after a month from the 4th session of ECP, average Thongprassom scale decreased from 4.3 ± 2.2 to 3.2 ± 1.2 points (p < 0.001). After treatment there was a significant reduction of the correlation of the interaction of CD3⁺CD8⁺ and СD38⁺ (r = 0.47; p > 0.05), indicating a significant reduction of the activation potential of CD3⁺CD8⁺, however, there is the possibility of maintaining immune surveillance of natural killer cells in the pathogenic microflora of the oral cavity. Conclusion. Practical application of complex therapy with the use of ECP and methotrexate in the treatment of atypical LP of the skin in combination with oral lesions is pathogenetically justified and effective.

atypical lichen planus, oral lichen planus, methotrexate, extracorporeal photochemotherapy, immunotherapy

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