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NEW YORK (Reuters Health) Apr 29 - Patients with symptomatic oral
lichen planus respond equally well to betamethasone oral mini-pulse
therapy and to topical triamcinolone acetonide, but they may respond
more quickly to betamethasone, results of a randomized comparative
study indicate.
Betamethasone oral mini-pulse 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 mini-pulse 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 mini-pulse therapy
consisting of 5 mg orally on 2 consecutive days per week and 24 matched
patients to triamcinolone acetonide (0.1%) oral paste applied three
times daily. Treatment continued for 3 months and then was tapered
during the next 3 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 mini-pulse 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 twelfth weeks onward, respectively. Patients with non-erosive
disease also responded faster to betamethasone.
"This suggests that oral mini-pulse may be preferred over topical
triamcinolone for achieving a quicker therapeutic response," Dr.
Khaitan and colleagues write.
Relapse occurred more frequently with betamethasone oral mini-pulse
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.
J Am Acad Dermatol 2008;58:596-602.
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