Department of Dermatology and Venereology, Hospital de Baza, Granada, Spain.
Translational Research Institute, Academic Health System, Medical School, Hamad Medical Corporation, Doha, Qatar.
J Eur Acad Dermatol Venereol. 2019 Oct;33(10):1847-1862. doi: 10.1111/jdv.15771. Epub 2019 Jul 22.
Lichen planus (LP) is a chronic-relapsing inflammatory skin disease. Although many drugs have been used for the management of LP, some of them lack the backup by strong therapeutic evidence, while others are not suitable for some patients due to safety profile issues. The aim of this study was to review the recent status of available medical therapies for LP to help physicians make better decisions upon best medical practice while facing patients with this condition. A review of published articles on management of LP was conducted with the MEDLINE and PubMed databases. The quality of the evidence was graded as high, moderate, low or very low. A total of 1366 articles were retrieved, and 219 (16%) were included in the final analysis. Twenty-one different treatment modalities were analysed. The quality of evidence was high for topical steroid and calcineurin inhibitor, while it was moderate for oral steroids. All the other modalities reached low or very low quality of evidence. Topical steroids and calcineurin inhibitors are the current first-line therapies, while for other therapies the strength of recommendation is not so evident. Unfortunately, larger randomized, controlled trials to support the efficacy, safety and tolerability of other therapies in LP are lacking, and many of them are recommended based on studies with small sample sizes, lack of standardized outcome measures or lack of controlled duration or even in anecdotal evidence. Thus, large-scale randomized clinical trials are still warranted to establish the exact benefits of other topical treatments, phototherapy, immunosuppressant and new immunomodulators for an optimized treatment of LP.
扁平苔藓（LP）是一种慢性复发性炎症性皮肤病。虽然有许多药物被用于 LP 的治疗，但其中一些缺乏强有力的治疗证据支持，而另一些由于安全性问题不适合某些患者。本研究旨在回顾 LP 现有医学治疗方法的最新状况，以帮助医生在面对患有这种疾病的患者时，根据最佳医疗实践做出更好的决策。通过 MEDLINE 和 PubMed 数据库对 LP 管理的已发表文章进行了综述。证据质量被评为高、中、低或极低。共检索到 1366 篇文章，最终分析纳入 219 篇（16%）。分析了 21 种不同的治疗方法。局部类固醇和钙调神经磷酸酶抑制剂的证据质量为高，而口服类固醇的证据质量为中。其他所有方法的证据质量均为低或极低。局部类固醇和钙调神经磷酸酶抑制剂是目前的一线治疗方法，而对于其他治疗方法，推荐强度并不明显。不幸的是，缺乏更大规模的随机对照试验来支持 LP 中其他疗法的疗效、安全性和耐受性，其中许多疗法是基于样本量小、缺乏标准化结局测量或缺乏对照持续时间甚至是轶事证据的研究而推荐的。因此，仍需要大规模的随机临床试验来确定其他局部治疗、光疗、免疫抑制剂和新型免疫调节剂在 LP 优化治疗中的确切益处。
