Efficacy and safety of oral methotrexate versus oral mini pulse betamethasone therapy in the treatment of lichen planus: a comparative study.

BACKGROUND: Lichen planus (LP) is a chronic inflammatory mucocutaneous disease. Systemic corticosteroids are the treatment of choice for generalized LP but their use is limited due to side effects. Oral mini pulse (OMP) therapy represents a good alternative. Also, Methotrexate (MTX) can be used as an alternative and safe modality in LP. OBJECTIVES: To compare the efficacy and safety of oral MTX versus OMP betamethasone in the treatment of different types of LP. PATIENTS AND METHOD: The study included 40 patients presenting with LP who were randomly divided into two groups. Group A for oral MTX 7.5 mg weekly & group B for OMP betamethasone 3 mg weekly for a maximum of 12 weeks. Basic laboratory investigations were done on both groups. Follow-up investigations were done on the 2nd, 4th, 8th and 12th weeks. The percentage of improvement in each patient was calculated on a scale according to the appearance of new lesions, degree of pruritus/pain, subsidence of cutaneous lesions and clearance of the oral lesion. RESULTS: In the MTX group, 55% of patients showed excellent improvement, 25% showed good improvement and 20% showed partial improvement. In the OMP group, 85% of patients showed excellent improvement, 10% showed good improvement and 5% showed partial improvement. The reported clinical and laboratory adverse effects were tolerable and didn't lead to the discontinuation of treatment. CONCLUSION: OMP betamethasone and low dose MTX may be considered effective and safe lines of treatment for different types of LP and may represent good and safe alternative options for conventional daily corticosteroid therapy.

Evaluation of the effect of pulsed dye laser on chronic psoriatic plaque.

BACKGROUND: Psoriasis is one of the most prevalent immune mediated skin diseases. Selective vascular destruction by pulsed dye laser is considered one of effective laser treatments. OBJECTIVE: Evaluation of the therapeutic effect of pulsed dye laser in treatment of chronic psoriatic plaque lesions and changes in human beta defensin-2(HBD-2) expression in the psoriatic patients before and after treatment, with correlation to the clinical improvement. METHODS: Twenty patients with psoriatic plaque on right side treated by laser and another plaque on left side similar in size and its severity score served as control receiving no treatment. Each patient received 3-4 sessions of pulsed dye laser 595 nm. Follow up was done for three months. RESULTS: There was statistically significant difference between the two psoriatic plaques (untreated and treated; A and B; p = .004). There was significant decrease in HBD-2 expression after treatment. No recurrence was observed during follow up period. CONCLUSION: The pulsed dye laser is safe, effective, and tolerable treatment for resistant stable localized plaque psoriasis with minimal side effects and prolonged recurrence period.