Betamethasone oral minipulse therapy an option in oral lichen planus

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NEW YORK (Reuters Health), Apr 29 - Patients with symptomatic oral lichen planus respond equally well to betamethasone oral minipulse therapy and to topical triamcinolone acetonide, but they may respond more quickly to betamethasone, results of a randomized comparative study indicate.

Betamethasone oral minipulse therapy "may be a useful and convenient alternative either as a monotherapy or to achieve rapid symptomatic relief during periods of exacerbations," the study team concludes in their report in the April issue of the Journal of the American Academy of Dermatology.

"We have successfully used betamethasone oral minipulse therapy in progressive vitiligo, extensive alopecia areata, and now in oral lichen planus," study investigator Dr. Binod K. Khaitan from the All India Institute of Medical Sciences in New Delhi, told Reuters Health.

Dr. Khaitan and colleagues assigned 25 patients with moderate to severe oral lichen planus to betamethasone oral minipulse therapy consisting of 5 mg orally on two consecutive days per week and 24 matched patients to triamcinolone acetonide (0.1%) oral paste applied three times daily. Treatment continued for three months and then was tapered during the next three months.

Twenty three patients from each arm completed the study. Both treatments were "effective in achieving adequate control of the disease in about two-thirds of cases and complete symptom-free state in up to half of cases," according to the investigators.

Compared with patients in the triamcinolone arm, patients in the betamethasone oral minipulse arm had more severe disease at the outset and they responded more rapidly to treatment, both objectively and subjectively.

The difference in average scores within each group was statistically significant from the fourth week on in the betamethasone arm and the eighth week on in the triamcinolone arm. In patients with erosive disease, statistically significant improvement was noted in the second and 12th weeks onward, respectively. Patients with nonerosive disease also responded faster to betamethasone.

"This suggests that oral minipulse may be preferred over topical triamcinolone for achieving a quicker therapeutic response," Dr. Khaitan and colleagues write.

Relapse occurred more frequently with betamethasone oral minipulse therapy, perhaps due to fast tapering of the drug, the study team suggests.

Side effects, which were more common with betamethasone pulse than with triamcinolone (56% vs. 25%), were "mild, temporary, quickly reversible and acceptable," the authors note.

By Megan Rauscher

J Am Acad Dermatol 2008;58:596-602.

Last Updated: 2008-04-29 13:15:44 -0400 (Reuters Health)

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