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Hollis AN, Myers EL, Culton DA. A retrospective cohort study of the efficacy of metronidazole in oral lichen planus. Clin Exp Dermatol 2023; 48:1354-1357. [PMID: 37585453 DOI: 10.1093/ced/llad268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/02/2023] [Indexed: 08/18/2023]
Abstract
Lichen planus (LP) is an inflammatory dermatosis with mucosal variants, including oral LP (OLP). OLP has a relapsing chronic course and may significantly affect a patient's quality of life. We analysed the efficacy of metronidazole as a treatment for OLP via a retrospective chart review of patients with a diagnosis of OLP seen at our institution over 10 years. Thirty patients with OLP were treated with metronidazole 500 mg twice daily. Most patients (n = 18; 60%) showed improvement with metronidazole, including 10 (33%) who experienced complete resolution of symptoms. Our results were limited by the retrospective nature of the review and the relatively small cohort size. Given the efficacy, mild side-effect profile and the less immunosuppressive nature of metronidazole vs. alternative systemic treatment options, metronidazole is a reasonable option to try in patients with symptomatic OLP who have failed topical treatment options.
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Affiliation(s)
- Alison N Hollis
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Emma L Myers
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Donna A Culton
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
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Husein‐ElAhmed H, Gieler U, Steinhoff M. Lichen planus: a comprehensive evidence‐based analysis of medical treatment. J Eur Acad Dermatol Venereol 2019; 33:1847-1862. [DOI: 10.1111/jdv.15771] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/21/2019] [Indexed: 12/15/2022]
Affiliation(s)
- H. Husein‐ElAhmed
- Department of Dermatology and Venereology Hospital de Baza Granada Spain
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
| | - U. Gieler
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
| | - M. Steinhoff
- Translational Research Institute Academic Health System Medical School Hamad Medical Corporation Doha Qatar
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
- College of Medicine Weill Cornell Medicine‐Qatar Doha Qatar
- Medical School Qatar University Doha Qatar
- College of Medicine Weill Cornell University New York NY USA
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Stehlikova Z, Kostovcikova K, Kverka M, Rossmann P, Dvorak J, Novosadova I, Kostovcik M, Coufal S, Srutkova D, Prochazkova P, Hudcovic T, Kozakova H, Stepankova R, Rob F, Juzlova K, Hercogova J, Tlaskalova-Hogenova H, Jiraskova Zakostelska Z. Crucial Role of Microbiota in Experimental Psoriasis Revealed by a Gnotobiotic Mouse Model. Front Microbiol 2019; 10:236. [PMID: 30846974 PMCID: PMC6394148 DOI: 10.3389/fmicb.2019.00236] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 01/28/2019] [Indexed: 12/18/2022] Open
Abstract
Psoriatic patients have altered microbiota, both in the intestine and on the skin. It is not clear, however, whether this is a cause or consequence of the disease. In this study, using an experimental mouse model of psoriasis induced by imiquimod (IMQ), we show that oral treatment with a broad spectrum of antibiotics (MIX) or metronidazole (MET) alone mitigates the severity of skin inflammation through downregulation of Th17 immune response in conventional mice. Since some antibiotics, including MET, can influence immune system reactivity, we also evaluated the effect of MIX in the same model under germ-free (GF) conditions. GF mice treated with MET did not show milder signs of imiquimod-induced skin inflammation (IISI) which supports the conclusion that the therapeutic effect is mediated by changes in microbiota composition. Moreover, compared to controls, mice treated with MIX had a significantly higher abundance of the genus Lactobacillus in the intestine and on the skin. Mice treated with MET had a significantly higher abundance of the genera Bifidobacterium and Enterococcus both on the skin and in the intestine and of Parabacteroides distasonis in the intestine. Additionally, GF mice and mice monocolonized with either Lactobacillus plantarum or segmented filamentous bacteria (SFB) were more resistant to IISI than conventional mice. Interestingly, compared to GF mice, IMQ induced a higher degree of systemic Th17 activation in mice monocolonized with SFB but not with L. plantarum. The present findings provide evidence that intestinal and skin microbiota directly regulates IISI and emphasizes the importance of microbiota in the pathogenesis of psoriasis.
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Affiliation(s)
- Zuzana Stehlikova
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Klara Kostovcikova
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Prague, Czechia.,Institute of Molecular Genetics of the Czech Academy of Sciences, v.v.i., Prague, Czechia
| | - Miloslav Kverka
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Prague, Czechia.,Institute of Experimental Medicine of the Czech Academy of Sciences, v.v.i., Prague, Czechia
| | - Pavel Rossmann
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Prague, Czechia
| | - Jiri Dvorak
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Prague, Czechia
| | - Iva Novosadova
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Prague, Czechia
| | - Martin Kostovcik
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Prague, Czechia.,BIOCEV, Institute of Microbiology, Czech Academy of Sciences, Vestec, Czechia
| | - Stepan Coufal
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Prague, Czechia
| | - Dagmar Srutkova
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Novy Hradek, Czechia
| | - Petra Prochazkova
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Prague, Czechia
| | - Tomas Hudcovic
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Novy Hradek, Czechia
| | - Hana Kozakova
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Novy Hradek, Czechia
| | - Renata Stepankova
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Novy Hradek, Czechia
| | - Filip Rob
- Department of Dermatology and Bulovka Hospital, Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Katerina Juzlova
- Department of Dermatology and Bulovka Hospital, Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Jana Hercogova
- Department of Dermatology and Bulovka Hospital, Second Faculty of Medicine, Charles University, Prague, Czechia
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Thandar Y, Maharajh R, Haffejee F, Mosam A. Treatment of cutaneous lichen planus (part 2): a review of systemic therapies. J DERMATOL TREAT 2018; 30:633-647. [DOI: 10.1080/09546634.2018.1544411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Yasmeen Thandar
- Faculty of Heath Sciences, Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Rivesh Maharajh
- Faculty of Heath Sciences, Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Firoza Haffejee
- Faculty of Heath Sciences, Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Anisa Mosam
- Department of Dermatology, University of KwaZulu-Natal and Nelson Mandela School of Medicine, Durban, South Africa
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Abstract
BACKGROUND Oral metronidazole has been reported to be effective in some patients with idiopathic lichen planus (LP) who did not have concomitant protozoal infections of the intestinal or genital tracts. OBJECTIVE Our purpose was to evaluate the efficacy of this drug in the treatment of generalized LP. METHODS Nineteen patients with LP who were free from intestinal and genital protozoal infections were treated with oral metronidazole, 500 mg twice daily, for 20 to 60 days and were followed up for a period of 5 to 36 months. RESULTS Fifteen patients (78.9%) improved with metronidazole treatment. Complete response was observed in 13 patients (7 women and 6 men). Two patients responded partially. Worsening of the lesions was observed in 1 of the 4 nonresponding patients. CONCLUSION Metronidazole may be an alternative therapy for the treatment of generalized LP. Its immunomodulatory activity seems to be a possible mechanism of action besides its antimicrobial activity.
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Affiliation(s)
- A Y Büyük
- Division of Dermatology, SSK Göztepe Educational Hospital, IStanbul, Turkey
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Abstract
Lichenoid dermatoses comprise a significant proportion of dermatologic conditions. The pathophysiologic mechanisms are unclear for many such dermatoses making treatment difficult. Ongoing research into these mechanisms is allowing more directed intervention possible. This article describes some of the recent experiences in the therapy of lichen planus, lichen nitidus, toxic epidermal necrolysis, and graft versus host disease.
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Affiliation(s)
- A S Boyd
- Department of Medicine (Dermatology), Vanderbilt University, Nashville, Tennessee, USA.
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Abstract
Lichen Planus is a relatively common inflammatory dermatosis of unknown origin. The present review summarizes the histological and clinical features of lichen planus and variants, including lichenoid drug reactions, are described. Possible mechanisms of pathogenesis of lichen planus are reviewed. The development of malignancy in association with lichen planus and the association with hepatitis are discussed. Treatment options for the more difficult manifestations of lichen planus are proposed.
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Affiliation(s)
- G Marshman
- Department of Medicine, Flinders Medical Centre, Bedford Park, Australia
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