From the Guidelines
Cyclosporin works in the treatment of lichen planus by suppressing the immune system, specifically targeting T-lymphocytes that are responsible for the inflammatory response in this condition, as supported by the British Association of Dermatologists guidelines 1.
Mechanism of Action
Cyclosporin inhibits calcineurin, an enzyme that activates T-cells, thereby reducing the production of inflammatory cytokines and interrupting the autoimmune process that causes lichen planus. This mechanism is crucial in reducing the symptoms of lichen planus, as noted in the guidelines for the safe and effective prescribing of oral ciclosporin in dermatology 1.
Treatment and Dosage
For treatment, cyclosporin is typically prescribed at doses of 3-5 mg/kg/day, divided into two daily doses, as mentioned in the american society of hematology 2019 guidelines 1. It can be used topically as a 0.1% mouth rinse for oral lichen planus, or systemically for severe or widespread disease. Treatment duration usually ranges from 8-12 weeks, with regular monitoring of blood pressure, kidney function, and drug levels required due to potential side effects.
Side Effects and Precautions
Patients should be aware that cyclosporin can cause hypertension, nephrotoxicity, increased risk of infections, and hirsutism, as highlighted in the british association of dermatologists guidelines 1. It's generally reserved for severe, recalcitrant cases of lichen planus that haven't responded to first-line treatments like corticosteroids. Patients taking cyclosporin should avoid grapefruit juice and certain medications that may interact with it, and should have baseline laboratory tests before starting treatment, as advised in the guidelines 1.
Key Considerations
- Regular monitoring of blood pressure, kidney function, and drug levels is required due to potential side effects.
- Patients should be aware of the potential side effects and precautions, including hypertension, nephrotoxicity, and increased risk of infections.
- Cyclosporin is generally reserved for severe, recalcitrant cases of lichen planus that haven't responded to first-line treatments.
- Baseline laboratory tests are necessary before starting treatment, and patients should avoid grapefruit juice and certain medications that may interact with cyclosporin.
From the FDA Drug Label
Cyclosporine is a potent immunosuppressive agent that in animals prolongs survival of allogeneic transplants involving skin, kidney, liver, heart, pancreas, bone marrow, small intestine, and lung The effectiveness of cyclosporine results from specific and reversible inhibition of immunocompetent lymphocytes in the G0- and G1-phase of the cell cycle. T-lymphocytes are preferentially inhibited. Cyclosporine also inhibits lymphokine production and release including interleukin-2
The mechanism of action of cyclosporin in the treatment of lichen planus is likely due to its immunosuppressive effects, specifically the inhibition of T-lymphocytes and the reduction of lymphokine production, including interleukin-2. This suggests that cyclosporin may work by suppressing the immune response that contributes to the development of lichen planus. 2
From the Research
Mechanism of Action of Cyclosporin in Lichen Planus
- Cyclosporin is an immunosuppressive medication that works by inhibiting the activity of T-lymphocytes, which are a type of white blood cell involved in the immune response 3, 4.
- In the context of lichen planus, cyclosporin is thought to reduce the inflammation and immune-mediated damage that characterizes the disease 5, 6.
Efficacy of Cyclosporin in Lichen Planus
- Studies have shown that cyclosporin can be effective in treating lichen planus, particularly in cases that are resistant to other treatments 3, 4.
- A short course of oral cyclosporin has been shown to alleviate symptoms, resolve clinical activity, and halt the progression of hair loss in patients with lichen planopilaris, a variant of lichen planus that affects the scalp 5.
- Cyclosporin has also been compared to other immunosuppressive medications, such as methotrexate, and has been found to have similar efficacy in treating refractory lichen planopilaris 6.
Comparison with Other Treatments
- Cyclosporin is one of several immunosuppressive medications that can be used to treat lichen planus, including methotrexate, azathioprine, and mycophenolate mofetil 3, 4.
- The choice of medication depends on the severity and extent of the disease, as well as the patient's overall health and medical history 4.
- Cyclosporin may be considered a second-line treatment for lichen planus, to be used when first-line treatments such as topical corticosteroids and phototherapy are not effective 3.