Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
Dermatology. 2013;226(4):302-10. doi: 10.1159/000349980. Epub 2013 Aug 15.
Therapy-resistant lichen planus (LP) can be a challenging condition for dermatologists. There are some case reports about successful treatments with alitretinoin of cutaneous and oral, but not of esophageal LP.
We present the unique case of a patient with cutaneous, oral and esophageal LP which was refractory to classical treatment options (topical clobetasol propionate and pimecrolimus, intramuscular triamcinolone acetonide); because of systemic side effects the patient did not tolerate systemic acitretin dosed up to 25 mg daily.
Oral alitretinoin was used at a dose of 30 mg daily.
Both oral and skin changes as well as dysphagia completely resolved within 4 weeks without any severe side effects and the drug was used for 6 months. No papules, intraoral striae or dysphagia recurred during the 6 months of treatment. After 4 months the patient relapsed with mucosal patches so that a second cycle was initiated for 6 months where oral LP lesions resolved after 4 weeks also (with sporadic mild headache).
Further studies are needed to better understand the impact of alitretinoin in LP. Our observation suggests alitretinoin as a new, well-tolerated treatment option for esophageal LP after failed response to conventional treatments.
治疗抵抗性扁平苔藓（LP）可能是皮肤科医生面临的一项挑战。有一些关于阿利特罗汀治疗皮肤和口腔 LP 成功的病例报告，但没有关于食管 LP 的报告。
我们报告了一例独特的病例，患者患有皮肤、口腔和食管 LP，对经典治疗方案（局部丙酸氯倍他索和吡美莫司、肌肉内曲安奈德）均无反应；由于全身副作用，患者不能耐受每天 25 毫克的全身阿维 A 酯。
口服阿利特罗汀，剂量为 30 毫克/天。
口腔和皮肤的变化以及吞咽困难在 4 周内完全缓解，没有任何严重的副作用，并且该药物使用了 6 个月。在治疗的 6 个月中，没有出现丘疹、口腔条纹或吞咽困难复发。4 个月后，患者出现黏膜斑块复发，因此开始了第二个 6 个月的周期，口腔 LP 病变在 4 周后也得到了缓解（偶尔出现轻度头痛）。
需要进一步研究以更好地了解阿利特罗汀在 LP 中的作用。我们的观察结果表明，阿利特罗汀是治疗常规治疗失败后食管 LP 的一种新的、耐受良好的治疗选择。
