Emerging treatments

Naltrexone

Naltrexone is an orally active opioid antagonist that influences a variety of systemic pathways, including the immune system, when used in low doses. This phenomenon has piqued the interest of researchers and practitioners in regard to the use of low-dose naltrexone as a potential treatment in the management of several autoimmune conditions. One systematic review suggests that low-dose naltrexone is safe and effective in the treatment of lichen planopilaris; however, additional evidence is needed for dosing and long-term treatment guidelines.[90]

Intralesional bacillus Calmette-Guerin (BCG) injection

Proposed as an alternative treatment option for patients with erosive oral LP.[55]​ One small randomized trial compared intralesional BCG with triamcinolone injection and concluded the treatments were equally effective.[91]

Phototherapy and laser therapy (for oral LP)

Phototherapy is used in the management of cutaneous LP, but its role in oral LP is less clear. One systematic review on phototherapy for oral LP found that although most studies reported positive results, heterogeneity and risk of bias were high.[92]​ Another systematic review reported significant improvements in oral LP after low-level laser therapy, but no conclusive evidence for effectiveness of photodynamic therapy.[93]​ Further research on these modalities for oral LP is required.

Chloroquine

An antimalarial drug suggested as an alternative treatment option for nail LP.[55]​ Evidence is limited to a single case report.[94]

Topical tacrolimus (for nail LP)

A calcineurin inhibitor used in the treatment of cutaneous and mucosal LP, but evidence for use in nail LP is limited. In one case series of five patients, topical tacrolimus improved nail LP after six months in all patients, with subsequent recurrence in one patient.[29]

Etanercept (for nail LP)

A tumor necrosis factor (TNF)- alpha antagonist. Etanercept is currently recommended for oral disease; however, one case report suggests it may be effective for nail LP, but further randomized studies are needed.[95]

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