Turkderm-Turk Arch Dermatol Venereol. 2025; 59(1): 7-12 | DOI: 10.4274/turkderm.galenos.2025.94659

A comparative analysis of acitretin and methotrexate in the treatment of lichen planus

Özge Sevil Karstarlý Bakay, Rahime Ekmekçioðlu
Pamukkale University Faculty of Medicine, Department of Dermatology and Venereology, Denizli, Türkiye

Background and Design: Lichen planus (LP) is a common inflammatory dermatosis affecting people of all ages. Acitretin is one of the firstline systemic treatments; however, certain circumstances limit its use and encourage the search for alternative therapies. We aimed to compare the efficacy and safety of methotrexate as an alternative to acitretin.
Materials and Methods: This study retrospectively evaluated the treatment response, clinical characteristics, and demographic features of patients who received methotrexate or acitretin for LP between January 2021-2024. Patients who showed clinical improvement and required continued treatment to maintain control were classified as “clinical responders”. Patients who demonstrated a clinical response and remained clear after treatment discontinuation were classified as in “remission”. Patients whose symptoms did not improve with treatment or who continued to develop new lesions were considered “non-responders”.
Results: The study included 66 patients. The mean age of the patients was 53.4±9.6; 47 (71.2%) were female, and 16 (28.8%) were male. Thirty-one (46.9%) patients took methotrexate, and 35 (53.1%) took acitretin. The clinical response rate in patients receiving methotrexate (n=30; 96.7%) was significantly higher than in patients taking acitretin (n=28; 80%) (p<0.05). The predicted treatment response duration did not differ significantly (p>0.05) between the group taking methotrexate (15.9 weeks) and the group taking acitretin (13.8 weeks). There was no statistically significant difference in the number and duration of patients achieving remission and the side effect rate of the treatments (p>0.05).
Conclusion: Methotrexate and acitretin are effective and safe options in LP treatment. Multicenter randomized controlled trials are needed to develop treatment guidelines.

Keywords: Lichen planus treatment, acitretin, methotrexate, treatment efficacy

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Liken planus tedavisinde asitretin ve metotreksatýn karþýlaþtýrmalý analizi

Özge Sevil Karstarlý Bakay, Rahime Ekmekçioðlu
Pamukkale Üniversitesi Týp Fakültesi, Dermatoloji Anabilim Dalý, Denizli, Türkiye

Amaç: Liken planus (LP) her yaþtan insaný etkileyen yaygýn görülen bir enflamatuvar dermatozdur. Asitretin sistemik tedavilerde birinci basamak tedavilerden biridir; ancak bazý durumlar kullanýmýný kýsýtlamakta ve alternatif tedavi arayýþlarýný teþvik etmektedir. Çalýþmamýzda asitretin alternatifi olarak metotreksatýn etkinliðini ve güvenliðini karþýlaþtýrmayý amaçladýk.
Gereç ve Yöntem: Ocak 2021-2024 tarihleri arasýnda LP tedavisi için metotreksat veya asitretin baþlanan hastalarýn tedavi yanýtý, klinik ve demografik özellikleri retrospektif olarak incelendi. Hastalarýn metotreksat ve asitretin tedavilerine yanýtý analiz edildi. Klinik iyileþme gösteren, yeni lezyonlarý olmayan ve kontrolü sürdürmek için devam eden tedaviye ihtiyaç duyan hastalar “klinik yanýt” olarak sýnýflandýrýldý. Klinik yanýt gösteren ve tedavinin kesilmesinden sonra temiz kalan hastalar “remisyon” olarak sýnýflandýrýldý. Her iki tedaviyle semptomlarý gerilemeyen veya yeni lezyon çýkýþlarý devam eden hastalar “tedaviye yanýtsýz” kabul edildi.
Bulgular: Çalýþmaya 66 hasta dahil edildi. Hastalarýn yaþ ortalamasý 53,4±9,6, kadýn hasta sayýsý 47 (%71,2) erkek hasta sayýsý 16 (%28,8) idi. Hastalarýn 31’i (%46,9) metotreksat, 35’i (%53,1) asitretin kullanmaktaydý. Metotreksat 10-15 mg/hafta subkutan, asitretin 20-35 mg/gün oral olarak kullanýlmýþtý. Metotreksat kullanan hastalarda klinik yanýt oraný (n=30, %96,7), asitretin kullananlardan (n=28, %80) anlamlý olarak daha fazlaydý (p<0,05). Metotreksat kullanýmý olan (15,9 hafta) grup ile asitretin kullanýmý olan (13,8 hafta) olan grup arasýnda öngörülen tedavi yanýt süresi anlamlý farklýlýk göstermemiþtir (p>0,05). Remisyona ulaþan hasta sayýsý ve süresi, tedavilerin yan etki oraný açýsýndan istatistiksel açýdan anlamlý fark yoktu (p>0,05).
Sonuç: Metotreksat ve asitretin LP tedavisinde etkili ve güvenli seçeneklerdir. Tedavi kýlavuzlarýnýn düzenlenmesi için çok merkez randomize kontrollü çalýþmalara ihtiyaç vardýr.

Anahtar Kelimeler: Liken planus tedavisi, asitretin, metotreksat, tedavi etkinliði

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