Mithra, S (2020) Comparison of Efficacy of Azathioprine, Dapsone and NB-UVB Phototherapy as Steroid Sparing Modalities in Generalised Lichen Planus Patients under Systemic Steroids. Masters thesis, Stanley Medical College, Chennai.
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Abstract
BACKGROUND: Generalised lichen planus (GLP) can affect skin, oral mucosa, genital mucosa, scalp, nails or all these sites with an over-all prevalence of 1% in a general population. It shows very less tendency to heal spontaneously. Generalised lichen planus (GLP) warrants longer duration of treatment for disease control. Limited studies are available in literature on treatment options of GLP unlike oral LP. AIM & OBJECTIVE: To determine the best modality of alternative treatment in combination with systemic steroids by comparing the efficacy, response rate, safety profile, side-effects and remission course of azathioprine, dapsone and NB-UVB phototherapy . METHODOLOGY: Randomised, prospective, comparative, non-blinded and interventional study with 30 patients in Group-A (azathioprine 2mg/kg/day), Group-B (Dapsone 2mg/kg/day) and Group-C (NB-UVB- Psoriatic incrementation dosage). ISI and DQLI were assessed at baseline and week-24. All patients received oral prednisolone (0.5-1 mg/kg/day) until there was no appearance of new lesions for consecutive 4 weeks and was continued on respective steroid sparing agents for 6 months. Routine investigations were done for every 4 weeks. Follow-up was done for 6 months. Response was assessed in terms of appearance of new lesions, flattening of lesions, Post-inflammatory hyperpigmentation and grading of all lesions every 4 weeks. RESULTS: In this study, the total number of female patients outnumbered males in each group with no statistical significance (p-value 0.125). The mean age of the patients was 34, 38 and 34 in group-A, B and C respectively showing no statistical significance between the groups (p-value 0.609). 50%, 42.3%, 37.5%had one or more co-morbidities and 50%, 57.7% ,62.5% had no comorbidities in group-A, B and C respectively with no statistical significance (p-value 0.655). ISI showed high statistical significance between the groups (p-value 0.0005). DLQI showed high statistical significance between the groups (p-value 0.0005). At week-24, appearance of new lesions was 0% in group-A, B & C and 3.8% in group-B with no significant p-value 0.363,flattening was present in 100% in group-A, B & C and p-value could not be calculated as the parameter was constant, PIH was present in 100% in group-A, B & C and p-value could not be calculated as the parameter was constant, Grade-3 lesions was present in 7.1% ,11.5%, 0%, grade-2 was present in 35.7%,76.9% ,8.3%,grade-1 lesions was present in 57.1% ,11.5%,91.3% in group-A,B & C respectively with highly significant p-value 0.0005. CONCLUSION: NB-UVB in combination with oral steroids showed better response in attaining good DLQI, ISI and disease control with minimal PIH and side-effects compared to azathioprine and dapsone. Azathioprine was better in achieving faster response and longer remission. Dapsone showed poor response in GLP in terms of disease control and side-effects like hyperbilirubinemia compared to NB-UVB and azathioprine. Side-effects of dapsone were seen in patients with multiple co-morbidities. On 6 months follow-up, remission was present in 100%, 76.9% and 87.5% in Group-A, B & C respectively.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201730053 |
| Uncontrolled Keywords: | Generalised Lichen Planus, Azathioprine, Dapsone, NB-UVB, DLQI, ISI. |
| Subjects: | MEDICAL > Dermatology Venereology and Leprosy |
| Depositing User: | Subramani R |
| Date Deposited: | 05 Feb 2021 01:51 |
| Last Modified: | 05 Feb 2021 01:51 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13864 |
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