Ann Dermatol.  2009 Aug;21(3):250-254. 10.5021/ad.2009.21.3.250.

Levamisole Monotherapy for Oral Lichen Planus

• Won TH
• Park SY
• Kim BS
• Seo PS
• Park SD

• KMID: 2266285
• DOI: http://doi.org/10.5021/ad.2009.21.3.250

Abstract

BACKGROUND: Several different kinds of drugs have been used to treat chronic oral lichen planus (OLP). During the last decade, there have been several reports demonstrating success with levamisole and low dose prednisolone therapy for treating OLP. However, some OLP patients who have underlying diseases such as diabetes, hypertension and malignancy are unable to take steroids.
OBJECTIVE
The aim of this study was to evaluate levamisole monotherapy for treating OLP.
METHODS
Eleven patients who had OLP were treated with levamisole between 2005 and 2007. The levamisole was administered at a dose 50 mg thrice daily for three consecutive days, but then it was not administered on the following four days.
RESULTS
After 2 weeks of treatment, 8 patients reported a partial response, 3 patients reported no response and no patients reported clearance of lesion. After 4 weeks of treatment, 6 patients reported a partial response, 3 patients reported no response and 2 patients reported clearance of lesion. Furthermore, after 3 months of treatment, 3 patients reported a partial response, 3 patients reported no response and 5 patients reported complete clearance of lesion. Clinical improvement was shown in 2 weeks, whilst the mean duration to achieve clearance of lesion was 6.2 weeks. Although 1 patient had mild itching, there were no significant adverse effects.
CONCLUSION
Levamisole monotherapy could be a successful and safe treatment option for patients with chronic OLP and who cannot take steroids.

Keyword

Levamisole; Oral lichen planus (OLP)

MeSH Terms

Humans
Hypertension
Levamisole
Lichen Planus, Oral
Prednisolone
Pruritus
Steroids
Levamisole
Prednisolone
Steroids

Figure

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  Fig. 1 Photography before and after 2 weeks of levamisole monotherpay (patient #4). Almost all the lesions of patient #4 faded away after 2 weeks of levamisole monotherapy (A: before treatment, B: after treatment).

Reference

1. Wilson E. On lichen planus. J Cutan Med Dis Skin. 1869. 3:117–132.

2. Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients. J Am Acad Dermatol. 2002. 46:207–214.

3. Carrozzo M, Gandolfo S. The management of oral lichen planus. Oral Dis. 1999. 5:196–205.

4. Eisen D, Griffiths CE, Ellis CN, Nickoloff BJ, Voorhees JJ. Cyclosporin wash for oral lichen planus. Lancet. 1990. 335:535–536.

5. Eisen D, Ellis CN, Duell EA, Griffiths CE, Voorhees JJ. Effect of topical cyclosporine rinse on oral lichen planus. A double-blind analysis. N Engl J Med. 1990. 323:290–294.

6. Eisen D, Ellis CN. Topical cyclosporine for oral mucosal disorders. J Am Acad Dermatol. 1990. 23:1259–1263.

7. Aufdemorte TB, De Villez RL, Gieseker DR. Griseofulvin in the treatment of three cases of oral erosive lichen planus. Oral Surg Oral Med Oral Pathol. 1983. 55:459–462.

8. Massa MC, Rogers RS 3rd. Griseofulvin therapy of lichen planus. Acta Derm Venereol. 1981. 61:547–550.

9. Sehgal VN, Abraham GJ, Malik GB. Griseofulvin therapy in lichen planus. A double-blind controlled trial. Br J Dermatol. 1972. 87:383–385.

10. Kaliakatsou F, Hodgson TA, Lewsey JD, Hegarty AM, Murphy AG, Porter SR. Management of recalcitrant ulcerative oral lichen planus with topical tacrolimus. J Am Acad Dermatol. 2002. 46:35–41.

11. Thomson MA, Hamburger J, Stewart DG, Lewis HM. Treatment of erosive oral lichen planus with topical tacrolimus. J Dermatolog Treat. 2004. 15:308–314.

12. Byrd JA, Davis MD, Bruce AJ, Drage LA, Rogers RS 3rd. Response of oral lichen planus to topical tacrolimus in 37 patients. Arch Dermatol. 2004. 140:1508–1512.

13. Sloberg K, Hersle K, Mobacken H, Thilander H. Topical tretinoin therapy and oral lichen planus. Arch Dermatol. 1979. 115:716–718.

14. Lu SY, Chen WJ, Eng HL. Dramatic response to levamisole and low-dose prednisolone in 23 patients with oral lichen planus: a 6-year prospective follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995. 80:705–709.

15. Lu SY, Chen WJ, Eng HL. Response to levamisole and low-dose prednisolone in 41 patients with chronic oral ulcers: a 3-year open clinical trial and follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998. 86:438–445.

16. Sun A, Chiang CP, Chiou PS, Wang JT, Liu BY, Wu YC. Immunomodulation by levamisole in patients with recurrent aphthous ulcers or oral lichen planus. J Oral Pathol Med. 1994. 23:172–177.

17. Sun A, Wang JT, Chia JS, Chiang CP. Serum interleukin-8 level is a more sensitive marker than serum interleukin-6 level in monitoring the disease activity of oral lichen planus. Br J Dermatol. 2005. 152:1187–1192.

18. Lewinski UH, Mavligit GM, Hersh EM. Cellular immune modulation after a single high dose of Levamisole in patients with carcinoma. Cancer. 1980. 46:2185–2194.

19. Redondo JM, Lopez-Guerrero JA, Fresno M. Potentiation of interleukin-2 activity by levamisole and imidazole. Immunol Lett. 1987. 14:111–116.

20. Amery WK, Bruynseels JP. Levamisole, the story and the lessons. Int J Immunopharmacol. 1992. 14:481–486.

21. Janssen PA. The levamisole story. Prog Drug Res. 1976. 20:347–383.

22. Cho NJ, Choi DY, Son SJ. Therapeutic effect of levamisole in recurrent aphthous stomatitis. Korean J Dermatol. 1979. 17:389–396.

23. Scheithauer W, Kornek GV, Marczell A, Karner J, Salem G, Greiner R, et al. Combined intravenous and intraperitoneal chemotherapy with fluorouracil+leucovorin vs fluorouracil+levamisole for adjuvant therapy of resected colon carcinoma. Br J Cancer. 1998. 77:1349–1354.

24. Sany J. Immunological treatment of rheumatoid arthritis. Clin Exp Rheumatol. 1990. 8:Suppl 5. 81–88.

25. Parsad D, Saini R, Negi KS. Comparison of combination of cimetidine and levamisole with cimetidine alone in the treatment of recalcitrant warts. Australas J Dermatol. 1999. 40:93–95.

26. Amer M, Tosson Z, Soliman A, Selim AG, Salem A, al-Gendy AA. Verrucae treated by levamisole. Int J Dermatol. 1991. 30:738–740.

27. Agarwal S, Ramam M, Sharma VK, Khandpur S, Pal H, Pandey RM. A randomized placebo-controlled double-blind study of levamisole in the treatment of limited and slowly spreading vitiligo. Br J Dermatol. 2005. 153:163–166.

28. Pasricha JS, Khera V. Effect of prolonged treatment with levamisole on vitiligo with limited and slow-spreading disease. Int J Dermatol. 1994. 33:584–587.

29. Rovensky J, Cebecauer L, Zitnan D, Lukac J, Ferencik M. Levamisole treatment of systemic lupus erythematosus. Arthritis Rheum. 1982. 25:470–471.

30. Renoux G, Renoux M, Teller MN, McMahon S, Guillaumin JM. Potentiation of T-cell mediated immunity by levamisole. Clin Exp Immunol. 1976. 25:288–296.

31. Kim HK, Jung YB, Lee EW. Clinical application of D-penicillamine and levamisole in rheumatoid arthritis. J Korean Orthop Assoc. 1983. 18:81–88.

32. Rosenthal M, Trabert U, Muller W. The effect of levamisole on peripheral blood lymphocyte subpopulations in patients with rheumatoid arthritis and ankylosing spondylitis. Clin Exp Immunol. 1976. 25:493–496.

33. Sany J. A review of the effects of levamisole on erythrocyte sedimentation rate, acute phase proteins, and anemia. J Rheumatol Suppl. 1978. 4:43–47.

34. Scott J, Dieppe PA, Huskisson EC. Continuous and intermittent levamisole. A controlled trial. Ann Rheum Dis. 1978. 37:259–261.