Treatment of Recalcitrant Lichen Planus with Low Molecular Weight Heparin (Enoxaparin): A Case Series Study among Iraqi Patients

93 Abstract Lichen planus (LP) is a unique, common, pruritic, inflammatory disease of the skin, mucous membranes and hair follicles. The exact pathogenesis of LP is unknown, but it is evident that immunologic mechanisms almost certainly mediate the development of LP. Cell mediated immunity plays the major role in triggering the clinical expression of the disease. Both CD4 and CD8 T-cells are found in lesional skin of LP. Low dose, low molecular weight heparin (enoxaparin) has been proven effective in various types of Lp. Enoxaparin has been shown to inhibit the expression of heparanase enzyme that is produced by CD4 lymphocytes (this enzyme is crucial in T-cell migration to target tissue). The Aim: is to evaluate the efficacy of low-dose enoxaparin in treatment of Iraqi patient with recalcitrant LP that is unresponsive to traditional courses of topical and systemic steroid therapy. Methods: Fifteen patients with recalcitrant LP were included in this study Enoxaparin was given to each patient in a dose of 3mg subcutaneous injection every week for a period of 20 weeks. Assessment of response to treatment was done for each patient every two weeks by assessment of the severity of itching and reduction in the number of lesions. VAS score used to assess improvement of itching. Patients divided into 3 groups (mild LP, moderate LP, and severe LP) according to the number of lesions at initial presentation. Response to treatment classified for 4 grades (no response, mild response, moderate response, dramatic response). Results: There was dramatic reduction in VAS score in 13 patients of the 15 patients (86.6%). This reduction is considered statistically significant in the end of the 1 month of treatment (pvalue 0.0002). The number of patients that respond to therapy in the end of treatment course was 12 patients (80%), this include all grades of improvement (mild 26.6%, moderate 20%, and dramatic 33.33%). patients with mild type LP showed a response of (83.33%) which is higher than the response rate of moderate type LP (71.42%). Conclusions: Enoxaparin is effective, safe, simple and good alternative therapy for acute and chronic recalcitrant lichen planus, specially those who complain from severe itching, those who use prolonged courses of steroid therapy without benefit and those with hypertrophic type LP. ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Introduction ichen planus (LP) is a unique, common, pruritic, inflammatory disease of the skin, mucous membranes and hair follicles [1]. It occurs throughout the world in all races and it represented about 1.2% of all new patients in clinical practice [2]. At least two thirds of cases occur between the ages of 30 and 60 years of age. No sexual predilection is evident [3]. The exact pathogenesis of LP is unknown, but it is evident that immunologic mechanisms almost certainly mediate the development of L Treatment of Recalcitrant Lichen Planus with Low Molecular Weight Heparin (Enoxaparin): A Case Series Study among Iraqi Patients