Topical Roflumilast for the Treatment of Cutaneous Lichen Planus in a Hispanic Patient
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Keywords
PDE-4 inhibitor, cutaneous lichen planus, roflumilast
Abstract
Background: Cutaneous lichen planus (CLP) is an immune-mediated disorder that traditionally affects middle-aged adults and can cause significant morbidity. CLP is often treated with topical corticosteroids, with additional therapy alternatives including phototherapy and systemic agents like oral corticosteroids, acitretin, methotrexate, and mycophenolate mofetil. Topical roflumilast is a phosphodiesterase-4 (PDE-4) inhibitor that is approved for plaque psoriasis, atopic dermatitis, and seborrheic dermatitis and has a favorable safety profile inhibits key pro-inflammatory cytokines. Oral PDE-4 inhibitors have previously demonstrated success in treating oral lichen planus and are thought to modulate type 1 interferon signaling implicated in the pathogenesis of CLP.
Case Presentation: We report the case of a 94-year-old woman with biopsy-confirmed CLP recalcitrant to hydrocortisone and minimally responsive to triamcinolone. She was treated with topical roflumilast once daily, resulting in significant clinical improvement within five weeks and near-complete resolution of lesions by six months, with only residual post-inflammatory hyperpigmentation.
Conclusion: This case highlights topical roflumilast as a novel steroid-sparing option for CLP, particularly in elderly patients or those in whom systemic therapy is not indicated. Further large-scale studies are warranted to validate its efficacy and long-term safety in the treatment of CLP.
References
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