Dupilumab for Lichen Planus Cutaneous Medicine for the Practitioner

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• In this case report, a 52-year-old man with biopsy-proven lichen planus (LP) was treated off-label with dupilumab after failing halobetasol ointment, tacrolimus ointment, oral prednisone, and acitretin. Itch intensity improved from 9/10 prior to therapy to 1/10 after 3 months of treatment with dupilumab.

• While LP is thought to be regulated primarily by the TH1 pathway, this patient's response to dupilumab suggests that there could be some underlying TH2-mediated inflammation. Further studies with additional patients are needed to determine the extent of TH2 involvement and utility of dupilumab for treating refractory LP.

–  Alex Noble, MD

Lichen planus (LP) is an inflammatory mucocutaneous disorder that primarily affects adults aged 30 to 60 years.1 It can present across various regions such as the skin, scalp, oral cavity, genitalia, nails, and hair. It classically presents with pruritic, purple, polygonal papules or plaques. The proposed pathogenesis of this condition involves autoimmune destruction of epidermal basal keratinocytes.2Management involves a stepwise approach, beginning with topical therapies such as corticosteroids and phototherapy and proceeding to systemic therapy including oral corticosteroids and retinoids. Additional medications with reported positive results include immunomodulators such as cyclosporine, tacrolimus, and mycophenolate mofetil.2-4Dupilumab is a biologic immunomodulator and antagonist to the IL-4Rα on helper T cells (TH1). Although indicated for the treatment of moderate to severe atopic dermatitis, this medication's immunomodulatory properties have been shown to aid various inflammatory cutaneous conditions, including prurigo nodularis.5-9 We present a case of dupilumab therapy for treatment-refractory LP.

Cutaneous Medicine for the Practitioner

Dupilumab for the Treatment of Lichen Planus

Cutis 2021 Apr 01;107(4)E8-E10, BT Pousti, A Jin, L Sklovar, KT Savage, LL Zhai, NK Mollanazar, CR Heath 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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