Pityriasis Lichenoides Medication

Updated: Sep 11, 2020
  • Author: Jeffrey P Callen, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

No randomized controlled trials have been performed in Mucha-Habermann disease. Since the disease course tends towards self-resolution, evaluation of treatments without adequate controls cannot result in rational recommendations. Nevertheless, a number of open trials have reported success with light therapy and oral medications.

Phototherapy has been reported useful in the treatment of subacute or chronic disease. [45] Psoralen plus UV-A (PUVA) therapy (150-200 J/cm2) has been reported, with as many as 4 treatments per week to a total of 30-35 treatments, depending on the patient's skin type. UV-A without psoralens and UV-B may result in clearing. Relapses are not uncommon. Narrow-band ultraviolet B phototherapy and photodynamic therapy have also been reported as effective. [46, 47, 48, 49, 50]

Case reports suggest the use of multiple oral medications including tetracycline, [15] azithromycin, erythromycin, sulfonamides, dapsone, chloroquine, streptomycin, isoniazid, penicillin, methotrexate (MTX), [51, 52] etretinate, and pentoxifylline. Potent topical corticosteroids may be useful if few lesions are present. Systemic corticosteroids and cyclosporin [53] may have a role in severe cases of PLEVA, but consideration of the systemic adverse effects of these medications is warranted. Despite a lack of randomized controlled trials, oral tetracycline and erythromycin have been prescribed most often in case series.

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Antibiotics

Class Summary

Antibiotics may have immunomodulatory activity. Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Tetracycline (Sumycin)

Tetracycline treats gram-positive and gram-negative organisms, as well as mycoplasmal, chlamydial, and rickettsial infections. It inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s).

Erythromycin (E.E.S., E-Mycin, Ery-Tab)

Erythromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is used for staphylococcal and streptococcal infections.

In children, age, weight, and severity of infection determine proper dosage. When twice-daily dosing is desired, half the total daily dose may be administered every 12 hours. For more severe infections, the dose is doubled.

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Psoralens

Class Summary

Tricyclic furocoumarins, when combined with UV radiation, produce DNA photoproducts resulting in suppression of both DNA synthesis and cell division.

Methoxsalen (Oxsoralen-Ultra, 8-MOP)

Methoxsalen inhibits mitosis by binding covalently to pyrimidine bases in DNA when photoactivated by UV-A.

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Retinoids

Class Summary

Retinoids regulate cell growth and proliferation.

Acitretin (Soriatane)

Acitretin is a retinoic acid analog, similar to etretinate and isotretinoin. Etretinate is the main metabolite and has demonstrated clinical effects close to those seen with etretinate. The mechanism of action is unknown.

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Antimetabolites

Class Summary

Methotrexate inhibits dihydrofolate reductase, thereby hindering DNA synthesis and cell reproduction.

Methotrexate (Folex, Rheumatrex)

Methotrexate may suppress the immune system. It ameliorates symptoms of inflammation (eg, pain, swelling, stiffness). A satisfactory response is seen in 3-6 weeks following administration. Adjust the dose gradually to attain a satisfactory response.

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