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Priscilla T, Parlapalli N. Effective treatment option for lichen planus: Steroids or low molecular weight heparins? INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2021. [DOI: 10.4103/ijdd.ijdd_31_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Thandar Y, Maharajh R, Haffejee F, Mosam A. Treatment of cutaneous lichen planus (Part 1): A review of topical therapies and phototherapy. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1582467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Yasmeen Thandar
- Department of Basic Medical Sciences, Faculty of Heath Sciences, Durban University of Technology, Durban, South Africa
| | - Rivesh Maharajh
- Department of Basic Medical Sciences, Faculty of Heath Sciences, Durban University of Technology, Durban, South Africa
| | - Firoza Haffejee
- Department of Basic Medical Sciences, Faculty of Heath Sciences, Durban University of Technology, Durban, South Africa
| | - Anisa Mosam
- Department of Dermatology, University of KwaZulu-Natal & Nelson Mandela School of Medicine, Durban, South Africa
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3
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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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Patel RP, Shastri MD, Ming LC, Zaidi STR, Peterson GM. Therapeutic Potential of Enoxaparin in Lichen Planus: Exploring Reasons for Inconsistent Reports. Front Pharmacol 2018; 9:586. [PMID: 29922163 PMCID: PMC5996198 DOI: 10.3389/fphar.2018.00586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 05/16/2018] [Indexed: 12/16/2022] Open
Abstract
Lichen planus (LP) is an uncommon mucocutaneous inflammatory condition, that is immunologically mediated, typically pruritic and often recurs. The currently advocated therapies are either not highly effective or associated with severe side effects. Enoxaparin, a widely used anticoagulant, is composed of both anticoagulant and non-anticoagulant fragments. Enoxaparin is reported to have anti-inflammatory properties and it was found to be effective in LP. However, the results from clinical studies have varied substantially and, therefore, the clinical role of enoxaparin in LP remains uncertain. This review focuses on potential reasons for the reported inconsistent outcomes, as well as proposing solutions; these include identifying batch-to-batch inconsistency in the composition of enoxaparin. The potential therapeutic value of enoxaparin in LP must be explored using well-designed clinical trials, combined with experimental studies that focus on identifying the anti-inflammatory fragments of enoxaparin and elucidating the mechanism of action of these non-anticoagulant fragments.
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Affiliation(s)
- Rahul P. Patel
- Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Madhur D. Shastri
- School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | - Long Chiau Ming
- Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
- School of Pharmacy, KPJ Healthcare University College, Nilai, Malaysia
- Vector-borne Diseases Research Group (VERDI), Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARA, Shah Alam, Malaysia
| | | | - Gregory M. Peterson
- Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
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Bolduc C, Sperling LC, Shapiro J. Primary cicatricial alopecia: Lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome. J Am Acad Dermatol 2017; 75:1081-1099. [PMID: 27846944 DOI: 10.1016/j.jaad.2014.09.058] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 12/19/2022]
Abstract
Both primary and secondary forms of cicatricial alopecia have been described. The hair follicles are the specific target of inflammation in primary cicatricial alopecias. Hair follicles are destroyed randomly with surrounding structures in secondary cicatricial alopecia. This 2-part continuing medical education article will review primary cicatricial alopecias according to the working classification suggested by the North American Hair Research Society. In this classification, the different entities are classified into 3 different groups according to their prominent inflammatory infiltrate (ie, lymphocytic, neutrophilic, and mixed). Part I discusses the following lymphocytic primary cicatricial alopecias: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome.
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Affiliation(s)
- Chantal Bolduc
- Department of Dermatology, University of Montreal, Montreal, Quebec, Canada.
| | - Leonard C Sperling
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jerry Shapiro
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Dermatology, New York University, New York, New York
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6
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Weston G, Payette M. Update on lichen planus and its clinical variants. Int J Womens Dermatol 2015; 1:140-149. [PMID: 28491978 PMCID: PMC5418875 DOI: 10.1016/j.ijwd.2015.04.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/02/2015] [Accepted: 04/06/2015] [Indexed: 12/24/2022] Open
Abstract
Lichen planus (LP) is an inflammatory skin condition with characteristic clinical and histopathological findings. Classic LP typically presents as pruritic, polygonal, violaceous flat-topped papules and plaques; many variants in morphology and location also exist, including oral, nail, linear, annular, atrophic, hypertrophic, inverse, eruptive, bullous, ulcerative, lichen planus pigmentosus, lichen planopilaris, vulvovaginal, actinic, lichen planus-lupus erythematosus overlap syndrome, and lichen planus pemphigoides. Clinical presentation of the rarer variant lesions may be largely dissimilar to classic LP and therefore difficult to diagnose based solely on clinical examination. However, histopathological examination of LP and LP-variant lesions reveal similar features, aiding in the proper diagnosis of the disease. Management of LP and LP variants aims to control symptoms and to decrease time from onset to resolution; it often involves topical corticosteroids, but varies depending on the severity and location of the lesion. The literature contains an array of reports on the variations in presentation and successful management of LP and its variants. A familiarity with LP and its variants is important in achieving timely recognition and management of the disease.
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Affiliation(s)
- Gillian Weston
- University of Connecticut School of Medicine, Farmington, CT
| | - Michael Payette
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
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Lean QY, Gueven N, Eri RD, Bhatia R, Sohal SS, Stewart N, Peterson GM, Patel RP. Heparins in ulcerative colitis: proposed mechanisms of action and potential reasons for inconsistent clinical outcomes. Expert Rev Clin Pharmacol 2015; 8:795-811. [PMID: 26308504 DOI: 10.1586/17512433.2015.1082425] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Current drug therapies for ulcerative colitis (UC) are not completely effective in managing moderate-to-severe UC and approximately 20% of patients with severe UC require surgical interventions. Heparins, polydisperse mixtures of non-anticoagulant and anticoagulant oligosaccharides, are widely used as anticoagulants. However, heparins are also reported to have anti-inflammatory properties. Unfractionated heparin was initially used in patients with UC for the treatment of rectal microthrombi. Surprisingly, it was found to be effective in reducing UC-associated symptoms. Since then, several pre-clinical and clinical studies have reported promising outcomes of heparins in UC. In contrast, some controlled clinical trials demonstrated no or only limited benefits, thus the potential of heparins for the treatment of UC remains uncertain. This review discusses potential mechanisms of action of heparins, as well as proposed reasons for their contradictory clinical effectiveness in the treatment of UC.
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Affiliation(s)
- Qi Ying Lean
- a 1 Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia.,b 2 Faculty of Pharmacy, University of Technology MARA, Puncak Alam , Selangor, Malaysia
| | - Nuri Gueven
- a 1 Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia
| | - Rajaraman D Eri
- c 3 School of Health Sciences, Faculty of Health, University of Tasmania, Launceston , Tasmania, Australia
| | - Rajesh Bhatia
- d 4 Royal Hobart Hospital , Hobart, Tasmania, Australia
| | - Sukhwinder Singh Sohal
- c 3 School of Health Sciences, Faculty of Health, University of Tasmania, Launceston , Tasmania, Australia.,e 5 Breathe Well Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia
| | - Niall Stewart
- a 1 Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia
| | - Gregory M Peterson
- a 1 Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia.,e 5 Breathe Well Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia.,f 6 Health Services Innovation Tasmania, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia
| | - Rahul P Patel
- a 1 Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia
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Lean QY, Eri RD, Randall-Demllo S, Sohal SS, Stewart N, Peterson GM, Gueven N, Patel RP. Orally Administered Enoxaparin Ameliorates Acute Colitis by Reducing Macrophage-Associated Inflammatory Responses. PLoS One 2015; 10:e0134259. [PMID: 26218284 PMCID: PMC4517792 DOI: 10.1371/journal.pone.0134259] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 06/25/2015] [Indexed: 02/07/2023] Open
Abstract
Inflammatory bowel diseases, such as ulcerative colitis, cause significant morbidity and decreased quality of life. The currently available treatments are not effective in all patients, can be expensive and have potential to cause severe side effects. This prompts the need for new treatment modalities. Enoxaparin, a widely used antithrombotic agent, is reported to possess anti-inflammatory properties and therefore we evaluated its therapeutic potential in a mouse model of colitis. Acute colitis was induced in male C57BL/6 mice by administration of dextran sulfate sodium (DSS). Mice were treated once daily with enoxaparin via oral or intraperitoneal administration and monitored for colitis activities. On termination (day 8), colons were collected for macroscopic evaluation and cytokine measurement, and processed for histology and immunohistochemistry. Oral but not intraperitoneal administration of enoxaparin significantly ameliorated DSS-induced colitis. Oral enoxaparin-treated mice retained their body weight and displayed less diarrhea and fecal blood loss compared to the untreated colitis group. Colon weight in enoxaparin-treated mice was significantly lower, indicating reduced inflammation and edema. Histological examination of untreated colitis mice showed a massive loss of crypt architecture and goblet cells, infiltration of immune cells and the presence of edema, while all aspects of this pathology were alleviated by oral enoxaparin. Reduced number of macrophages in the colon of oral enoxaparin-treated mice was accompanied by decreased levels of pro-inflammatory cytokines. Oral enoxaparin significantly reduces the inflammatory pathology associated with DSS-induced colitis in mice and could therefore represent a novel therapeutic option for the management of ulcerative colitis.
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Affiliation(s)
- Qi Ying Lean
- Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
- Faculty of Pharmacy, University of Technology MARA, Puncak Alam, Selangor, Malaysia
| | - Rajaraman D. Eri
- School of Health Sciences, Faculty of Health, University of Tasmania, Launceston, Tasmania, Australia
| | - Sarron Randall-Demllo
- School of Health Sciences, Faculty of Health, University of Tasmania, Launceston, Tasmania, Australia
| | - Sukhwinder Singh Sohal
- School of Health Sciences, Faculty of Health, University of Tasmania, Launceston, Tasmania, Australia
- Breathe Well Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Niall Stewart
- Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Gregory M. Peterson
- Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
- Breathe Well Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
- Health Services Innovation Tasmania, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Nuri Gueven
- Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Rahul P. Patel
- Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
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Low-Molecular-Weight Heparins as Immunomodulators in Dermatology Practice. Am J Ther 2015; 23:e1911-e1917. [PMID: 25853237 DOI: 10.1097/mjt.0000000000000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Low-molecular-weight heparins (LMWHs) have some effects on cell proliferation and inflammation beyond mere anticoagulation. They have been tried on treatment of a few dermatological disorders such as lichen planus, skin wound healing, recurrent aphtous stomatitis, chronic urticaria, and contact hypersensitivity. LMWHs are generally well-tolerated drugs, rarely can lead to severe reactions. In this article, we will review the novel indications of LMWHs in dermatology practice and common skin reactions associated with their use.
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Lean QY, Patel RP, Stewart N, Sohal SS, Gueven N. Identification of pro- and anti-proliferative oligosaccharides of heparins. Integr Biol (Camb) 2014; 6:90-9. [PMID: 24310794 DOI: 10.1039/c3ib40206a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Heparins, unfractionated heparin (UFH) and low molecular weight heparins (LMWHs), are heterogeneous mixtures of anticoagulant and non-anticoagulant oligosaccharides. In addition to their well-known anticoagulant effect, heparins have shown to mediate a wide range of non-anticoagulant effects, including the modulation of cellular growth. However, contradictory results have been reported with regard to their effects on cellular proliferation, with some studies suggesting anti-proliferative while others indicating pro-proliferative effects. This study investigated the proliferation of human colonic epithelial cancer cells in the presence of UFH and LMWHs (enoxaparin and dalteparin). In our experimental setting, all heparins caused a dose-dependent reduction in cellular growth, which correlated well with the induction of cell cycle arrest in the G₁ phase and which was not associated with significant changes in cell viability. The effects on cellular proliferation of 14 different oligosaccharides of enoxaparin obtained through ion-exchange chromatography were also assessed. Surprisingly, only two oligosaccharides showed distinctive anti-proliferative effects while the majority of oligosaccharides actually stimulated proliferation. Interestingly, the smallest oligosaccharide devoid of any anticoagulant activity showed the strongest anti-proliferative effect. Notably, heparins are currently standardised only according to their anticoagulant activity but not based on other non-anticoagulant properties. Our results indicate that slight differences in the composition of heparins' non-anticoagulant oligosaccharides, due to different origins of material and preparation methods, have the potential to cause diverse effects and highlight the need for additional characterisation of non-anticoagulant activities.
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Affiliation(s)
- Qi Ying Lean
- School of Pharmacy, University of Tasmania, Hobart, TAS, Australia.
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Iraji F, Asilian A, Saeidi A, Siadat AH, Saeidi AR, Hassanzadeh A. Comparison of therapeutic effect of low-dose low-molecular-weight heparin (enoxaparin) vs. oral prednisone in treatment of patients with lichen planus; A clinical trial. Adv Biomed Res 2013; 2:76. [PMID: 24223391 PMCID: PMC3814546 DOI: 10.4103/2277-9175.115798] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 02/03/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate and compare the therapeutic efficacy of subcutaneous enoxaparin versus oral prednisone (as a standard treatment) in patients with disseminated lichen planus. MATERIALS AND METHODS In this parallel randomized clinical trial study, overall 48 patients completed the study. 25 patients were treated with subcutaneous enoxaparin 5 mg weekly and 23 patients with 0.5 mg/kg prednisone orally daily until complete remission or a maximum of 8 weeks. The results of itching severity, extent of active lesions and drug side effects were compared. In remission, patients were followed for 6 months for recurrent lesions. RESULTS In enoxaparin group, 8 patients (32%) had complete remission and 10 patients (40%) had partial improvement. In the oral prednisone group, 16 patients (69.6%) had complete remission and 6 patients (26.1%) had partial improvement (P = 0.005). Average size of active lesions in both groups decreased significantly after treatment, but analysis of covariance showed that the mean lesion size after treatment in the oral prednisone group was significantly lower than the enoxaparin group (P = 0.005). The relapse rate from improved patients in the enoxaparin group was 6 (33%) and in oral prednisone group was 9 (40.9%, P = 0.083). In the enoxaparin group no serious complications was seen. But 22% in the oral prednisone group show side effect, the most common complications were dyspepsia. CONCLUSION Low dose enoxaparin on lichen Planus have therapeutic effect and is important for the least side effects but not as much as oral prednisone. But it could be accepted as an alternative treatment.
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Affiliation(s)
- Fariba Iraji
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Science, Isfahan, Iran
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Ion exchange chromatographic separation and isolation of oligosaccharides of intact low-molecular-weight heparin for the determination of their anticoagulant and anti-inflammatory properties. Anal Bioanal Chem 2013; 405:6043-52. [PMID: 23712644 DOI: 10.1007/s00216-013-6996-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
Abstract
It is well known that enoxaparin, a widely used anticoagulant and low-molecular-weight heparin containing a large number of oligosaccharides, possesses anti-inflammatory activity. Whilst enoxaparin has shown promising results in various inflammatory disorders, some of its oligosaccharides have anti-inflammatory properties and others increase the risk of bleeding due to their anticoagulant effects. The aim of this study was to develop an effective ion exchange chromatographic (IC) technique which allows the separation, isolation and, consequently, the identification of different oligosaccharides of enoxaparin with or without anticoagulant activity. The developed method utilises a semi-preparative CarboPac PA100 (9 × 250 mm) ion exchange column with sodium chloride gradient elution and UV detection at 232 nm. The method successfully resolved enoxaparin into more than 30 different peaks. IC-derived oligosaccharides with high, moderate, low or no anticoagulant activity were identified using an anti-factor Xa assay. The anti-inflammatory activity of selected oligosaccharides was investigated using the Griess assay. Using this technique, the oligosaccharides of enoxaparin with low or no anticoagulant activity, whilst exhibiting significant anti-inflammatory activity, could be fractionated. This technique can provide a platform to identify the oligosaccharides which are devoid of significant anticoagulant activity and are responsible for the therapeutic effects of enoxaparin that have been observed in various inflammatory conditions.
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Akdeniz S, Harman M, Atmaca S, Yaldiz M. The management of lichen planus with low-molecular-weight heparin (enoxaparin). Int J Clin Pract 2005; 59:1268-71. [PMID: 16236078 DOI: 10.1111/j.1742-1241.2005.00589.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aim of this study is to evaluate the efficiency of low-dose, low-molecular-weight heparin (enoxaparin) in the treatment of lichen planus (LP). Twenty-four patients clinically and histopathologically diagnosed as LP with intense pruritus were treated with 3 mg of enoxaparin (Clexane), subcutaneously once a week for 4-14 weeks. Complete remission was observed in 20 of 24 patients (83%) who had widespread cutaneous involvement, but no or minimal effect was observed in four of 24 patients, three of whom had chronic hypertrophic LP. Low-dose enoxaparin was observed to be effective in the treatment of LP without any side-effects. Enoxaparin may be an effective and simple alternative therapy for LP.
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Affiliation(s)
- S Akdeniz
- Department of Dermatology, University of Dicle, Diyarbakir, Turkey.
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Ferahbas A, Uksal U, Kutlugun C, Kontas O. Low-molecular-weight heparin (enoxaparin) in the treatment of lichen planus. J Eur Acad Dermatol Venereol 2003; 17:604-5. [PMID: 12941111 DOI: 10.1046/j.1468-3083.2003.00732.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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