Adalimumab in the management of cutaneous and oral lichen planus

Lichen planus (LP) is a common, chronic, inflammatory dermatosis that may involve the skin as well as oral and genital mucosa. Characterized by distinctive purplish papules often featuring white reticular scale, LP commonly is resistant to treatment. My patient presented with extensive, violaceous, and lacelike whitish lesions on the distal extremities, including the hands and feet, and the vulva. Approximately 10% to 12% of her body surface area (BSA) was involved, and her condition became progressively worse over time, with thick plaques developing on the buccal mucosa and tongue. After several conventional therapies failed, the patient underwent treatment with adalimumab, a tumor necrosis factor (TNF) antagonist. An almost clear response was noted by week 6, and the patient's lesions remained almost fully resolved after week 22. Additional studies are warranted to investigate the efficacy and safety of adalimumab for the treatment of LP.