Hydroxychloroquine for the management of recalcitrant oral lichen planus

OBJECTIVE

The objective of this study is to describe the efficacy of hydroxychloroquine (HCQ) in patients with oral lichen planus (OLP) refractory to conventional therapy.

STUDY DESIGN

In this single-center retrospective study, patients were prescribed HCQ 200 mg twice daily. Pain, reticulation, erythema, and ulceration scores were recorded. Two-sample and paired t tests were used to evaluate mean and paired pain scores and paired t test to determine substantial differences in paired REU scores, at HCQ initiation visit and final follow-up at 12 to 24 months.

RESULTS

Thirty-six patients (69.4% female) with a median age of 70 ± 12.0 (range 48-99) were initiated on HCQ. Only 30 patients were evaluable because pruritus developed in 5 patients (13.9%) and gastrointestinal symptoms in 1 (2.8%). The mean follow-up was 23.2 months (range 1-74). In 19 patients, there was a significant decline in the worst pain score from a mean of 3.9 (SD± 2.8, n = 19) to 1.9 (SD ± 2.4, n = 19) (t = 2.837, P < .006). Paired reticulation, erythema, and ulceration (REU scores) decreased from a weighted mean score of 16.0 (SD ± 8.0, n = 12) to 12.0 (SD ± 6.3, n = 12) (t = 2.07, P < .032).

CONCLUSION

Hydroxychloroquine was a suitable option and effective in reducing symptoms and disease severity in patients with recalcitrant OLP who do not adequately respond to standard therapy.

Oral Lichen Planus: An Update on Diagnosis and Management

Oral lichen planus (OLP) is a chronic inflammatory disease whose pathogenesis involves a T-cell mediated, epithelium-directed inflammation in response to unknown antigen(s). The disease evolves by intermittent flares and displays polymorphous clinical features (reticular, erosive, atrophic, plaque, papular, bullous, etc.). When present, symptoms vary depending on the clinical form and range from discomfort to severe pain. Topical superpotent corticosteroids constitute the first-line treatment of symptomatic flares, whereas a wide range of second/third-line treatments are available among topical calcineurin inhibitors, systemic corticosteroids, systemic retinoids, topical/systemic immunomodulators, etc. Follow-up of patients is necessary to detect transformation into squamous cell carcinoma, occurring in approximately 1% of patients.

[Translated article] Hydroxychloroquine: An Essential Drug in Dermatology and Its Controversial Use in COVID-19

Hydroxychloroquine is an antimalarial drug with immunomodulatory, anti-inflammatory, antibacterial, and antiviral properties. It has a good safety profile, can be used in children and in pregnant and breastfeeding women, and does not suppress the immune system. Regular screening for retinopathy, one of the drug’s most feared adverse effects, is necessary. Hydroxychloroquine is a widely used, essential drug in dermatology. Clinical response rates are good in lupus erythematous, where it is a first-line therapy, as well in numerous autoimmune/inflammatory diseases, including lichen planus, polymorphic light eruption, porphyria cutanea tarda, granuloma annulare, and sarcoidosis. In 2020, it was widely prescribed both to prevent and to treat COVID-19 caused by SARS-CoV-2. Its increased use led to serious supply shortages and in some cases stocks were entirely depleted. Recent meta-analyses have concluded that hydroxychloroquine is ineffective against COVID-19 and have advised against its use.

[Hydroxychloroquine: An Essential Drug in Dermatology and Its Controversial Use in COVID-19]

Hydroxychloroquine is an antimalarial drug with immunomodulatory, anti-inflammatory, antibacterial, and antiviral properties. It has a good safety profile, can be used in children and in pregnant and breastfeeding women, and does not suppress the immune system. Regular screening for retinopathy, one of the drug's most feared adverse effects, is necessary. Hydroxychloroquine is a widely used, essential drug in dermatology. Clinical response rates are good in lupus erythematous, where it is a first-line therapy, as well in numerous autoimmune/inflammatory diseases, including lichen planus, polymorphic light eruption, porphyria cutanea tarda, granuloma annulare, and sarcoidosis. In 2020, it was widely prescribed both to prevent and to treat COVID-19 caused by SARS-CoV-2. Its increased use led to serious supply shortages and in some cases stocks were entirely depleted. Recent meta-analyses have concluded that hydroxychloroquine is ineffective against COVID-19 and have advised against its use.

Hydroxychloroquine: An Essential Drug in Dermatology and Its Controversial Use in COVID-19

Hydroxychloroquine is an antimalarial drug with immunomodulatory, anti-inflammatory, antibacterial, and antiviral properties. It has a good safety profile, can be used in children and in pregnant and breastfeeding women, and does not suppress the immune system. Regular screening for retinopathy, one of the drug's most feared adverse effects, is necessary. Hydroxychloroquine is a widely used, essential drug in dermatology. Clinical response rates are good in lupus erythematous, where it is a first-line therapy, as well in numerous autoimmune/inflammatory diseases, including lichen planus, polymorphic light eruption, porphyria cutanea tarda, granuloma annulare, and sarcoidosis. In 2020, it was widely prescribed both to prevent and to treat COVID-19 caused by SARS-CoV-2. Its increased use led to serious supply shortages and in some cases stocks were entirely depleted. Recent meta-analyses have concluded that hydroxychloroquine is ineffective against COVID-19 and have advised against its use.

In silico evaluation of drugs used in treatment of oral lichen planus

BACKGROUND

Oral lichen planus (OLP) is a chronic T cell-mediated, immunological, mucocutaneous disease with a number of genes and inflammatory mediators implicated in its pathogenesis. Heart shock protein 70 and the proinflammatory mediator TNFα have been predominantly involved in the etiopathogenesis of oral lichen planus.

METHODS

In this study, the action of 27 commonly used drugs for treating OLP at HSP70 and TNFα were evaluated by molecular docking using Maestro Schrodinger version 10.1. X-ray crystallographic structures of the target proteins, that is, Heat Shock Protein 70 (PDB Code: 6FDT) and tumor necrosis factor alpha-1 (PDB Code: 1TNF) were obtained from Protein Data Bank (PDB). The structures of the ligands (27 drugs) were obtained from PubChem in.sdf format. Using Ligprep, pre-processing of the ligands was done. Extra-precision docking was performed with the prepared protein and the ligands.

RESULTS

With respect to HSP70, the highest dock score (-4.768) and glide score (-4.818) were seen with hydroxychloroquine (HCQ), followed by epigallocatechin gallate (green tea), methotrexate, and curcumin. The highest dock (-9.525) and glide score (-9.584) in TNFα were seen in with epigallocatechin gallate, followed by HCQ, dapsone, and methotrexate.

CONCLUSION

The results of the study tend to explain the clinical use of HCQ in recalcitrant and severe cases, as well as the anti-inflammatory property of epigallocatechin gallate. The results of the study open ventures for exploring the in silico behavior of drugs for effective pathological management.

Hydroxychloroquine in dermatology: New perspectives on an old drug

Hydroxychloroquine is an age-old drug whose use as an immunomodulatory agent with a low side-effect profile continues to expand. We present a review of this drug including recently updated prescribing recommendations and a summary of its clinical application in dermatology. A maximum daily dose of 5.0 mg/kg based on actual body weight and no greater than 400 mg is advised in order to reduce the risk of retinopathy, which is potentially permanent and has an estimated prevalence of 7.5% at 5 years on standard dosing. Baseline ophthalmologic assessment followed by annual screening after 5 years is recommended; however, closer monitoring should be considered in the setting of existing retinopathy, a cumulative dose > 1000 g or renal dysfunction. Hydroxychloroquine is now considered to be safe in pregnancy, and routine glucose-6-phosphate dehydrogenase (G6PD) deficiency testing is not required. Smoking can significantly decrease its efficacy although the reason is still uncertain. Hydroxychloroquine appears to also demonstrate antineoplastic and cardioprotective benefits.

Clinical Management of Oral Lichen Planus: A Systematic Review

Aim:

The clinical management of OLP represents a considerable challenge for the oral physician. The aim of this review is to assess the main intervention used in the management of OLP and the efficacy of every type of treatment.

Materials & Methods:

We searched and analyzed PubMed database for articles on OLP management. Only randomized controlled trials, comparing an active treatment with placebo, or between different active treatments, were considered in this systematic review. Only patients with symptomatic OLP were included and interventions of all types were considered (topical treatment, systemic drugs, non pharmacological intervention).

Results:

A total of 25 randomized controlled trials were examined and included in this review. Steroids are the most frequently employed drug in the treatment of OLP and their efficacy and safety are demonstrated. Also calcineurin inhibitors and photo-dynamic therapy are used in different studies for OLP management, with positive results.

Conclusion:

Topical steroids remain the first-line treatment for symptomatic OLP, however, many different pharmacological and non-pharmacological therapies would represent a valid alternative for its management, but, nowadays they require further investigations.