Lichen Planus: What is New in Diagnosis and Treatment?

IF 8.6 1区 医学 Q1 DERMATOLOGY
Burak Tekin, Fangyi Xie, Julia S. Lehman
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Abstract

Lichen planus (LP), an idiopathic, multifaceted chronic inflammatory disease with a heterogeneous clinical presentation, affects approximately 0.5–1% of the population. The various clinical manifestations of LP fall into three broad categories, namely cutaneous, appendageal, and mucosal, with further subclassification depending on the morphology and distribution patterns of individual lesions. There is mounting evidence that LP has systemic associations, including autoimmune conditions, glucose intolerance, dyslipidemia, and cardiovascular disorders. Cutaneous hypertrophic and mucosal forms of LP are at a heightened risk for malignant transformation. Familiarity with these potential associations in conjunction with long-term follow-up and regular screening could lead to a timely diagnosis and management of concomitant conditions. In addition, the frequent quality of life (QoL) impairment in LP underscores the need for a comprehensive approach including psychological evaluation and support. Several treatment strategies have been attempted, though most of them have not been adopted in clinical practice because of suboptimal benefit-to-risk ratios or lack of evidence. More recent studies toward pathogenesis-driven treatments have identified Janus kinase inhibitors such as tofacitinib, phosphodiesterase-4 inhibitors such as apremilast, and biologics targeting the interleukin-23/interleukin-17 pathway as novel therapeutic options, resulting in a dramatic change of the treatment landscape of LP. This contemporary review focuses on the diagnosis and management of LP, and places emphasis on more recently described targeted treatment options.

Abstract Image

扁平苔癣:诊断和治疗的新进展?
扁平苔藓(LP)是一种特发性、多发性慢性炎症疾病,临床表现多种多样,约占总人口的 0.5-1%。扁平苔藓的各种临床表现可分为三大类,即皮肤类、阑尾类和粘膜类,并可根据单个病变的形态和分布模式进一步细分。越来越多的证据表明,LP 与全身性疾病有关,包括自身免疫性疾病、葡萄糖不耐受症、血脂异常和心血管疾病。皮肤肥厚型和粘膜型 LP 恶变的风险更高。熟悉这些潜在的关联,并进行长期随访和定期筛查,可以及时诊断和处理并发症。此外,LP 患者的生活质量(QoL)经常受到损害,这也强调了采取包括心理评估和支持在内的综合方法的必要性。目前已尝试了多种治疗策略,但由于疗效风险比不理想或缺乏证据,大多数治疗策略尚未被临床采用。最近,针对发病机制驱动治疗的研究发现,Janus 激酶抑制剂(如托法替尼)、磷酸二酯酶-4 抑制剂(如阿普瑞司特)和靶向白细胞介素-23/白细胞介素-17 通路的生物制剂是新的治疗选择,从而使 LP 的治疗格局发生了巨大变化。这篇当代综述的重点是 LP 的诊断和管理,并着重介绍了最新的靶向治疗方案。
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来源期刊
CiteScore
15.20
自引率
2.70%
发文量
84
审稿时长
>12 weeks
期刊介绍: The American Journal of Clinical Dermatology is dedicated to evidence-based therapy and effective patient management in dermatology. It publishes critical review articles and clinically focused original research covering comprehensive aspects of dermatological conditions. The journal enhances visibility and educational value through features like Key Points summaries, plain language summaries, and various digital elements, ensuring accessibility and depth for a diverse readership.
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