Lichen Myxedematosus Medication

Updated: Mar 11, 2019
  • Author: Elizabeth A Liotta, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

Several chemotherapeutic agents have been tried [16] ; of these, the most common is melphalan.

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Alkylating agents

Class Summary

Successful short-term improvements are reported with melphalan treatment; however, in one study, a significant number of cases had fatal complications due to hematologic malignancies and sepsis.

Melphalan (Alkeran)

Melphalan inhibits mitosis by cross-linking DNA strands.

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

Prednisone (Deltasone, Orasone, Meticorten)

Prednisone is for use in a cyclic protocol with melphalan. It is an immunosuppressant for the treatment of autoimmune disorders; it may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Prednisone stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.

A case report describes systemic corticosteroid therapy; improvement in the skin was noted within 4 weeks.

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Immune Globulins

Class Summary

Therapeutic improvements have been reported with the use of intravenous immunoglobulins with or without thalidomide or lenalidomide. The dosage is based on case reports and multicenter studies, typically 2 g/kg/month IV divided over 2-5 days, with cycles repeated every 6-8 weeks depending on response and remission. There have been no randomized trials performed.

Immune globulin IV (Gammagard S/D, Carimune NF)

This is off-label use. Intravenous immune globulin is pooled human immune globulins from donors and is used as replacement therapy for primary and secondary immunodeficiencies; it may interfere with Fc receptors on the cells of the reticuloendothelial system for autoimmune disorders, including cytopenias and ITP; it may offer passive immunity by increasing antibody titers and antigen-antibody reaction potential.

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Immunomodulator

Class Summary

Therapeutic improvements have been reported with the use of intravenous immunoglobulin with or without thalidomide or lenalidomide. A case report of marked improvement within 2 months has been described in 3 patients prescribed thalidomide 100 mg PO qd/bid (up to 300 mg/day if needed). Improvement continued after 4 months. GI upset associated with thalidomide may be reduced with divided doses. Another case report describes use of lenalidomide 25 mg/day PO for 3 weeks each month.

Lenalidomide (Revlimid)

This is off-label use. Its mechanism of action is not fully understood. The active metabolite inhibits pyrimidine nucleotide synthesis and elicits antiproliferative action against T-cells.

Thalidomide (Thalomid)

This is off-label use. Thalidomide suppresses tumor necrosis factor-alpha and down-modulates cell surface adhesion molecules involved in leukocyte migration. Anticancer activity may be due to inhibition of angiogenesis.

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