Dermatology Online Journal

Background: Lichen planus is an inflammatory disease that affects the skin, the oral mucosa, or both.  Generalized cutaneous lichen planus may pose a therapeutic challenge for clinicians if the condition persists or flares after topical or systemic corticosteroid therapy.

Purpose: Acitretin, a systemic retinoid, can be considered a potential second-line treatment for patients with generalized cutaneous lichen planus.  Herein, we describe a postmenopausal woman with generalized cutaneous lichen planus who was successfully treated with acitretin.

Methods: A 58-year-old woman presented with generalized cutaneous lichen planus involving her upper and lower extremities as well as her lower back.  After failing corticosteroid therapy, she was started on acitretin 20 mg/day, which was later increased to 30 mg/day.  To review the literature on the use of acitretin in cutaneous lichen planus, we used the PubMed search engine and searched for the terms “acitretin” and “cutaneous lichen planus.”

Results: Our patient had complete resolution of pruritus within one week of initiating acitretin 20 mg/day.  After an increase in dose to 30 mg/day, the cutaneous lesions completely resolved over a 3-month period.  There was no recurrence of disease as acitretin was tapered and discontinued.

Conclusion: Generalized cutaneous lichen planus may pose a therapeutic challenge for the symptomatic relief of skin lesions.  Topical and systemic corticosteroids are first-line treatments.  In patients who fail corticosteroids, relapse after corticosteroid therapy, or have contraindications to corticosteroids, acitretin may be considered a potential second-line therapy.