Treatment of cutaneous lichen planus (part 2): a review of systemic therapies.

Although numerous medications are available for the treatment of cutaneous lichen planus (CLP), recurrence is common and there is a lack of evidence of efficacy of many treatment options. Part 1 reviewed consolidated evidence from topical therapies and phototherapy. In Part 2, all systemic treatments are assessed. All English studies, regardless of design, investigating the outcome of systemic treatment for CLP, until January 2018, were included. While there were only a few well-designed randomized control trials (RCTs), evidence was extrapolated and graded from open trials, case series as well as case reports. Mini pulse therapy with corticosteroids should be considered over moderate daily dosing with retinoids being an alternative option. Low-dose methotrexate is considered effective and safe provided it is regularly monitored. Azathioprine, cyclosporine and mycophenolate mofetil require larger more defined RCTs in resistant CLP. Low-molecular-weight heparins may be considered in patients with no response to first-line treatment. Biologics are potentially promising but there is a need for RCTs with a considerable duration to determine their long-term safety profiles. Evidence with various other drugs were reported. Clinicians may have a broader perspective on the efficacy of treatments across all study profiles.