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Abstract
Background: Lichen planus (LP) is a chronic immune-mediated inflammatory condition that affects the skin and mucous membranes, and can cause considerable morbidity and reduced quality of life. Traditional treatment options are limited by inadequate response and side effects. The phosphodiesterase-4 inhibitor apremilast has shown promise and appears to be safe.
Objective: To assess the treatment response to apremilast in Lichen planus patients and to determine the clinical factors associated with treatment response.
Materials and Methods: A total of 90 patients with biopsy-proven lichen planus who did not respond to topical steroids were enrolled in this single arm prospective Cohort study. All patients received apremilast 30 mg twice daily for 12 weeks as per the routine departmental protocol. Efficacy was measured as improvement in Physician Global Assessment (PGA) of at least 2 grades. The secondary outcomes were Subject Global Assessment (SGA), pruritus Visual Analog Scale (VAS), Dermatology Life Quality Index (DLQI) and Target Area Lesion Symptom Score (TALSS).
Result: Efficacy was achieved in 27.8% of patients, while 44.4% demonstrated ≥50% improvement in SGA. Complete clearance occurred in 5.6%. Significant improvements were observed in PGA, pruritus VAS, DLQI, and TALSS (p<0.001). Shorter disease duration and lower body surface area involvement were associated with treatment response, whereas presence of diabetes mellitus was inversely associated with treatment response.
Conclusion: Apremilast was well tolerated and associated with treatment response treatment in patients with lichen planus, especially in the early stages and mild disease. It presents a good alternative to traditional systemic treatments.