Effectiveness of Oral Methotrexate Therapy versus Systemic Corticosteroid Therapy in Treatment of Generalised Lichen Planus

Abstract

Objective: To compare the effectiveness of oral methotrexate versus systemic corticosteroids in treatment of lichen planus.

Study design: Randomised controlled trial.

Place and duration of study: Department of Dermatology, Lady Reading Hospital, Peshawar from September 2013 to February 2014.

Methodology: Patients with generalised lichen planus involving at least 20% of total body area diagnosed clinically and were randomly allocated into two equal groups by lottery method. Patients in group A were subjected to oral methotrexate 10 mg once weekly for eight weeks with standard monitoring of full blood count and liver and renal function tests. Patients in group B were subjected to oral corticosteroids 40 mg for eight weeks taken daily than tapered according to the protocol. The results were assessed at baseline and at the eighth week after starting the treatment. The responses were analysed by Visual Analogue Scale (VAS) and sorted into four categories: 0-3 = poor response, 4-5 = moderate, 6-7 = good, and >7 excellent response. Chi-square test was applied to compare the efficacy in two groups with significance of less than or equal to 0.05.

Results: Group A (methotrexate) had 47 (60%) male patients and 32 (40%) female patients. Group B (oral corticosteroids) had 51 (64%) male patients and 28 (36%) females. Group A 55 (70%) patients had lichen planus in <50% of the body; whereas in group B 53 (67%) patients had lichen planus in <50% of the body. Methotrexate was effective in 63 (80%) patients; whereas, oral corticosteroid was effective in 57 (72%) patients. No remarkable side effects were observed with either agent.

Conclusion: Methotrexate is more efficacious than systemic corticosteroids, but the effect is not statistically significant.