Low dose Methotrexate for the treatment of generalized lichen planus

Background: Lichen planus is a common inflammatory disease that can involve the skin, nails, mucous membrane, and hair follicles. There is a long list of topical and systemic therapies for its treatment. Methotrexarte has some characteristics that make it a good choice for generalized lichen planus. Aim: The goal of this study was to assess the effect of low dose methotrexate in generalized lichen planus. Method: Eighteen patients (8 male and 10 female, mean age: 51.1, range: 22-80, SD: 14.9) with generalized lichen planus were enrolled in the study. After basic evaluations, low dose methotrexate (7.5-10 mg weekly) initiated. The response rate was appraised after 2, 4 and 8 weeks. Six-month follow-up was done for evaluating the recurrence rate. Result: At the end of the 8th week, 75% of the patients had more than 75% improvement. After six months, no case of recurrence was reported. Adverse effects were limited to laboratory abnormalities in two patients (abnormal liver function tests in one case and decreased hemoglobin in the other case). Conclusion: Low dose methotrexate is a very good and safe treatment for generalized lichen planus, especially when there is concern regarding the steroids undesired effects or when the disease is resistant to corticosteroids.