Treatment of erosive vulvovaginal lichen planus with tofacitinib: A case series
Abstract
ALT: alanine aminotransferase ELP: erosive lichen planus EVVLP: erosive vulvovaginal lichen planus GI: gastrointestinal JAK-STAT: janus kinase e signal transducer and activator of transcription LP: lichen planus MACE: major adverse cardiac events INTRODUCTION Lichen planus (LP) is a chronic inflammatory skin disease that affects cutaneous and mucosal sites and is often recalcitrant to topical therapies. Erosive lichen planus (ELP) is a severe variant which is often less responsive to therapy. ELP tends to occur on the oral and anogenital mucosa and modified mucous membranes but can also involve other mucosal sites, such as the esophagus. ELP significantly affects quality of life (QOL) and if left untreated, can lead to chronic scarring. Erosive vulvovaginal LP (EVVLP) can lead to narrowing of the introitus and midline fusion, resulting in pain, itch, irritation, dyspareunia, dysuria, and recurrent urinary tract infections due to urinary retention and obstruction. Topical immunosuppression with corticosteroids or calcineurin inhibitors are usually considered firstline for EVVLP, while resistant disease may be treated with intralesional, oral, or intramuscular steroids. Studies have estimated that up to 40% ofwomenwith EVVLP do not respond to first-line topical steroid therapy and require systemic agents. Steroidsparing agents such as methotrexate, mycophenolate mofetil, hydroxychloroquine, and rituximab have been used with varying levels of efficacy. Thus, there is…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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