Interventions for cutaneous lichen planus (Protocol)

Gorouhi F, Firooz A, Khatami A, Ladoyanni E, Bouzari N, Kamangar F, Gill JK

This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane
Library 2009, Issue 4
http://www.thecochranelibrary.com

Interventions for cutaneous lichen planus (Protocol)

Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
 TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Interventions for cutaneous lichen planus (Protocol) i

Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Protocol]

Interventions for cutaneous lichen planus

Farzam Gorouhi1 , Alireza Firooz2 , Alireza Khatami2 , Effie Ladoyanni3 , Navid Bouzari4 , Farin Kamangar5 , Jagjot Kaur Gill6
1 Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran. 2 Center for

Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran. 3 Corbett Hospital, Dudley
Group of Hospitals NHS Trust, Stourbridge, UK. 4 Dermatology, University of Miami, Miami, Florida, USA. 5 Department of Public
Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, USA. 6 c/o The Cochrane Skin Group,
Nottingham University, Nottingham, UK

Contact address: Farzam Gorouhi, Children’s Hospital Oakland Research Institute (CHORI), Children’s Hospital & Research Center,
5700 Martin Luther King Jr, Oakland, California, 94609, USA. gorouhif@gmail.com. gorouhif@yahoo.com.

Editorial group: Cochrane Skin Group.

Publication status and date: New, published in Issue 4, 2009.

Citation: Gorouhi F, Firooz A, Khatami A, Ladoyanni E, Bouzari N, Kamangar F, Gill JK. Interventions for cutaneous lichen planus.
Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD008038. DOI: 10.1002/14651858.CD008038.

Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT
This is the protocol for a review and there is no abstract. The objectives are as follows:
To evaluate all interventions for cutaneous lichen planus.

Interventions for cutaneous lichen planus (Protocol) 1

Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
BACKGROUND
Description of the condition
Lichen planus is a common condition that affects the skin, mu-
cous membranes, nails, hair, and oesophagus. In its classic form,
lichen planus is characterised by itching red-purple papules most
commonly on the extremities of middle-aged adults (Boyd 1991).
The classic skin lesions of lichen planus are characterised by shiny,
red to purple-coloured, flat-topped, papules, sometimes showing
a small central depression. A thin, transparent, and adherent scale
may be located on top of the lesion. Fine, whitish points or net-
works referred to as Wickham’s striae may be present over the sur-
face of well-developed papules.
Oral lichen planus is a variant of cutaneous lichen planus in which
the oral mucosa is involved. The most common clinical manifesta-
tion of oral lichen planus is a lesion with network pattern, mostly
inside the mouth (Shiohara 2008).
Mucosal lichen planus is a broader term by comparison with oral
lichen planus. It includes lichen planus affecting the vagina and
vulva in which oral involvement also commonly coexists (Shiohara
2008).
Clinical subtypes
Cutaneous lichen planus (CLP) has different clinical subtypes: an-
nular, linear, hypertrophic, atrophic, vesiculobullous, palmoplan-
tar, follicular, actinic, and lichen planus pigmentosus.
In annular lichen planus papules spread in a circular fashion and
the centre is clear, and in linear lichen planus the papules are
arranged in a line which usually follows a line named “Blaschko
line”. The Blaschko line does not run along the blood vessel or the
lymph duct.
Hypertrophic lichen planus manifests as extremely itchy thickened
areas of skin mostly on the tops of the feet or shins, whereas in
atrophic lichen planus papules coalesce together forming a slightly
depressed centre.
Vesiculobullous lichen planus may appear in two different forms:
1-bullous lichen planus, in which blisters occur in already existing
lichen planus lesions, and 2-lichen planus pemphigoides in which
blisters occur primarily on skin that is not affected by lichen planus.
Erosive and ulcerative lichen planus is commonly observed in
lichen planus affecting the palms or soles with ulcerating areas.
In follicular lichen planus, involvement of the hair follicles is
prominent. This is also known as lichen plano pilaris. The tops of
the hair follicles become bumpy with a purple-coloured rim which
is most commonly observed on the scalp.
Actinic lichen planus is a variant of lichen planus which has been
reported to occur more commonly among Middle Eastern indi-
viduals and presents as reddish-brown skin lesions on the sun-ex-
posed areas of the patients such as the forehead and neck. Actinic
lichen planus commonly occurs during spring and summer and
may resemble other forms of facial presentation such as melasma.
Interventions for cutaneous lichen planus (Protocol)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Lichen planus pigmentosus usually manifest on the sun-exposed
areas (e.g. face and neck) of darker-skinned individuals. The af-
fected areas are typically much darker (hyperpigmented) (Shiohara
2008).
Epidemiology and Causes
The annual incidence of lichen planus was reported as 32 per every
100,000 men and 37 per every 100,000 women in the United
Kingdom over the period 1994 to 2003 (Pannell 2005). Overall
prevalence varies from 0.22% to 1% of the general population (
Shiohara 2008). Although no racial predilection has been observed
(Boyd 1991) one reference has suggested that lichen planus may
be more common among Indian ethnicities in Singapore (Theng
2004). In a Nigerian study lichen planus constituted 5% of all
skin cases (Alabi 1981).
Lichen planus occurs chiefly in people aged over 45 years (Pannell
2005), and it occurs between the ages of 30 and 60 years in at least
two-thirds of cases. No sexual predilection is evident. Women are
usually affected in their fifties and sixties, whereas men develop
lichen planus at an earlier age. The disease is less common in
very young and elderly individuals. In addition, development of
lichen planus may be affected by factors such as stress and cigarette
smoking (Boyd 1991).
Immunologic mechanisms mediate the development of lichen
planus.
In early lesions of lichen planus, it has been shown that activated
helper T lymphocytes predominate in the deeper layers of the skin
(Schiller 2000; Sugerman 2000). The activation of T lymphocytes
results in the production of chemical signals such as interleukin-
2, interferon gamma, and TNF-α and TNF-ß (tumour necrosis
factors -α and -ß) with subsequent recruitment of more T cells
and induction of the upper skin cells (keratinocytes) to produce
chemical messages (Pinkus 1973; Sugerman 2000). Cytotoxic T
lymphocytes, lymphotoxins, and cytokines may damage the skin.
TNF-α is a potent chemical messenger that may play a role in
pathogenesis of lichen planus (Thongprasom 2006). A few inves-
tigators have found an elevated level of another chemical messen-
ger called interleukin-6 in patients with oral lichen planus or gen-
eralised CLP compared with that in control people (Karagouni
1994; Yamamoto 1994; Toruniowa 1995). This suggests that in-
terleukin-6 may be a useful marker in evaluating therapeutic ef-
fects and in monitoring the disease status of oral lichen planus.
In addition, Toruniowa and colleagues found significantly greater
serum concentrations of interleukin-6 in generalised CLP than
in limited CLP, suggesting that the extensiveness of the disease
may influence serum interleukin-6 levels in the blood (Toruniowa
1995).
Other various environmental, behavioural, or infectious fac-
tors have been observed on occasion to be associated with the
development or exacerbation of lichen planus like hyperlipi-
daemia, smoking, hepatitis C virus, TT (transmission transfusion)
virus, human papillomavirus, and amalgam fillings (Boyd 1991;
2
Rodríguez-Iñigo 2001; Lodi 2004; Khovidhunkit 2008; Dreiher
2009). However, no well-established association has been docu-
mented between emotional stress, tobacco use, oral or gastroin-
testinal candidiasis, hepatitis, diabetes mellitus, autoimmune dis-
eases, internal malignancies, and development of lichen planus.
Impact
Lichen planus is an unpredictable chronic disease that typically
persists for one to two years which may follow a chronic, but re-
lapsing course over many years. The duration varies according to
the extent and site of involvement and type of lesions. An av-
erage duration of 1 year for patients with skin involvement and
17 months for skin and mucous membrane disease are reported
(Tompkins 1955). Interestingly, generalised eruptions tend to have
a rapid course and heal spontaneously faster than limited cuta-
neous disease. Lichen plano pilaris is one of the most chronic and
often progressive disease variants with little potential for hair re-
growth following inflammation and destruction of the hair follicles
(Mehregan 1992). Hypertrophic lichen planus typically follows a
protracted, unremitting course (Boyd 1991) and rarely may trans-
form into squamous cell carcinoma (Patel 2003). Lichen planus
patients may have moderate to severe depression (Akay 2002) and
also may have many other psychiatric problems such as hypochon-
driasis and hysteria (Ivanovski 2005).
Description of the intervention
Various drugs have been proposed for the treatment of cutaneous
lichen planus and the majority of the reports on these drugs consist
of a small series of patients or anecdotes. Many of the advocated
treatments lack conclusive evidence for efficacy (Cribier 1998).
Treatments consist of topical or systemic corticosteroids,
retinoids, vitamin D3 analogues, immunosuppressives, topical im-
munomodulators, phototherapy, laser surgery, cryosurgery, anti-
coagulant agents, and anti-microbial/anti-fungal agents.
Generally, there is a huge gap in evidence about different therapeu-
tic options; for example, it is disappointing that until 1990 there
were no published studies on oral corticosteroids despite numer-
ous recommendations concerning the use of them (Cribier 1998).
In 1990, Kellett and Ead were the first researchers to show the ef-
fectiveness of oral corticosteroids (prednisolone) in the treatment
of oral lichen planus (Kellett 1990).
Why it is important to do this review
Cutaneous lichen planus is a chronic disease which is charac-
terised by eruptions of red to purple-coloured, scaling papules and
plaques. These plaques typically are intensely itchy with some de-
gree of pigmentation. Hence, it may cause unwanted and some-
times intolerable defects in patient’s satisfaction and quality of
Interventions for cutaneous lichen planus (Protocol)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
life (e.g. self-esteem, perception of appearance, intimate relations,
worry, possible concerns about the carcinogenic nature of the dis-
ease). The risk of squamous cell carcinoma increases in oral lichen
planus and hypertrophic lichen planus (Shiohara 2008).
Although the cutaneous form has a better prognosis than the mu-
cosal form, it remains as a major concern for its discomfort and
cosmetic problems. Almost all the treatments available are disap-
pointing because they are only partially effective or controversial.
At best they need to be used throughout life as a maintenance
therapy in most cases.
A review on interventions for oral lichen planus was published in
1999. The authors did not extract any cutaneous lichen planus
data and remained focused on oral lichen planus (Chan 1999). To
the best of our knowledge, Cribier 1998 is the only other author
who has written a systematic review on interventions for CLP.
We wish to systematically review the evidence for the best thera-
peutic option(s) for cutaneous lichen planus.
OBJECTIVES
To evaluate all interventions for cutaneous lichen planus.
METHODS
Criteria for considering studies for this review
Types of studies
We will consider all randomised controlled trials (RCTs) of any
design that evaluate the effectiveness of any intervention for cuta-
neous lichen planus.
Types of participants
We will include studies in which a physician diagnosed cutaneous
lichen planus clinically and/or histopathologically. Skin involve-
ment in these patients can be with or without oral involvement.
Types of interventions
We will include studies that compare at least one active treatment
with a control which may be a placebo, no treatment, or an alter-
native intervention. We will consider all treatments including but
not limited to the following categorised therapies:
• Topical corticosteroids
• Systemic corticosteroids
• Retinoids (e.g. acitretin, etretinate, oral isotretinoin, and
temarotene)
• Vitamin D3 analogues (e.g. KH 1060, calcipotriol)
3
 • Topical immunomodulators (e.g. pimecrolimus, tacrolimus)
• Immunosuppressives
• Phototherapy (e.g. UVA, UVB, PUVA)
• Surgery (cryosurgery, laser therapy)
• Anti-microbials (e.g. metronidazole, griseofulvin,
miconazole, hydroxychloroquine)
• Biological therapies (e.g. alefacept, adalimumab)
• Complementary and alternative medicine (e.g.
homeopathic medicine, traditional Chinese medicine)
Types of outcome measures
Primary outcomes
The proportion of participants with complete clearance of all le-
sions.
Secondary outcomes
Improvement in quality of life (generic, dermatology specific, dis-
ease specific, or patient-generated index), as filled out by the par-
ticipant.
• The proportion of participants with resolution of itching,
as rated by the participant.
• The proportion of participants without any erythema in the
involved area, as rated by the assessor.
• The proportion of participants with the same thickness in
the involved area as compared with patient’s normal skin, as
rated by the assessor or participant.
• The proportion of participants with normal pigmentation
in the involved area, as rated by the assessor or participant.
• Global scores (0 to 3 scale defined as none, mild, moderate,
severe) or Visual Analogue Scores (0 to 100) of thickness,
pigmentation, pruritus, or erythema, as rated by the assessor or
participant.
• More than 75% clearance of lesions, as rated by assessor.
• The proportion of participants developing adverse side-
effects.
Timing of outcomes
The end point closest to 8 weeks (6 to 10 weeks) will be used for
primary and secondary outcomes but we will also consider other
efficacy and follow-up cut-off points.
Adverse outcomes
We will record:
a) the appropriateness of the methods used to detect adverse
events;
b) the adequacy of reporting.
We will describe the information qualitatively.
Interventions for cutaneous lichen planus (Protocol)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Search methods for identification of studies
Electronic searches
We will identify relevant trials from:
• The Cochrane Skin Group Specialised Register
• The Cochrane Central Register of Controlled Trials
(Clinical Trials) in The Cochrane Library (last update)
• MEDLINE (from 2005)
• PubMed (most recent records)
• EMBASE (from 2007)
• CINAHL (Cumulative Index to Nursing and Allied Health
Literature, from 1982)
• AMED (Allied and Complementary Medicine, from 1985)
• LILACS (Latin American & Caribbean Health Sciences
Literature, from inception)
• ACP journal club (American College of Physicians, from
1991)
The UK Cochrane Centre has an ongoing project to systemati-
cally search MEDLINE and EMBASE for reports of trials which
are then included in the Cochrane Central Register of Controlled
Trials. Searching has currently been completed in MEDLINE to
2004 and in EMBASE to 2006. Further searching will be under-
taken for this review by the Cochrane Skin Group to cover the
years that have not been searched by the UK Cochrane Centre.
We have devised a draft search strategy for MEDLINE in Appendix
1 which will be adapted to include additional search terms where
necessary and will be modified for the other databases listed.
Ongoing Trials
We will search the following online databases for ongoing trials
using the search term ’lichen’:
The metaRegister of Controlled Trials www.controlled-trials.com
The U.S. National Institutes of Health Ongoing Trials Register
www.clinicaltrials.gov
The Australian and New Zealand Clinical Trials Registry
www.anzctr.org.au
The World Health Organization International Clinical Trials Reg-
istry platform www.who.int/trialsearch
The Ongoing Skin Trials Register on www.nottingham.ac.uk/
ongoingskintrials
Searching other resources
Conference proceedings
We will scan the abstracts of the following major dermatology
meetings: the American Academy of Dermatology, the European
Association of Dermatology and Venereology, and the Society for
Investigative Dermatology for the years 2008 and 2009 for further
RCTs.
4
Unpublished literature
We will try to identify any unpublished or ongoing trials via cor-
respondence with trial authors of included and excluded trials less
than 15 years old.
Grey Literature
We will attempt to find unpublished studies through searching the
“Dissertations & Theses” database in ProQuest LLC’s website.
Adverse effects
We will document the incidence and severity of all recorded local
and systemic adverse events, at any time point, in all included
and excluded studies (for which we have obtained the full text).
Pharmaceutical companies will be asked for surveillance data on
adverse events.
Reference lists
We will search the bibliographies of all papers that we obtain in
full text for relevant trials. Additionally, we will search the bibli-
ographies of reviews published on cutaneous lichen planus in the
past 10 years.
Language restrictions
No language restrictions will be imposed and translations will be
sought where necessary.
Data collection and analysis
Selection of studies
Titles and abstracts identified from the searches will be checked
by two authors (FG, AK). The full text of all RCTs of possible
relevance will be independently assessed by two authors (FG, AK).
The authors will decide which trials fit the inclusion criteria. Any
disagreements will be resolved by consensus. Where ambiguities
exist trial authors will be contacted for clarification.
Data extraction and management
Two authors (FG, NB) will independently extract the data using a
specifically designed data extraction form, and discrepancies will
be resolved by consensus; the decision will be documented and,
where necessary, the trial authors contacted to help resolve the is-
sue. FG and AK will check the data and enter them independently
into RevMan and discrepancies will be resolved by consensus. The
authors will not be blinded to the names of trial authors, journal,
or institutions.
Interventions for cutaneous lichen planus (Protocol)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Assessment of risk of bias in included studies
The quality assessment will include an evaluation of the following
components for each included study, as outlined in the Cochrane
Collaboration’s tool for assessing risk of bias (Higgins 2008):
1) sequence generation (was the allocation sequence adequately
generated?)
2) allocation concealment (was allocation adequately concealed?)
3) blinding of participants, personnel, and outcome assessors (was
knowledge of the allocated intervention adequately prevented dur-
ing the study?)
4) incomplete outcome data (were incomplete outcome data ade-
quately addressed?)
5) selective outcome reporting (are reports of the study free of
suggestion of selective outcome reporting?)
6) other sources of bias (was the study apparently free of other
problems that could put it at a high risk of bias?)
Scores will not be assigned to individual trials and the system will
not be used to accept or reject trials.
In addition, these components will be assessed:
7) degree of certainty that participants have cutaneous lichen
planus (histopathology as the preferred method vs clinical diagno-
sis);
8) was there an adequate follow-up duration (a minimum of 12-
week follow-up)?
9) the baseline comparability of the participants between treat-
ment groups for age, sex, relevant past medical history, duration,
location, and severity of cutaneous lichen planus.
The information will be recorded in the ’Risk of Bias’ table as part
of the Characteristics of Included Studies table and a description of
the quality of each study will be given based on these components.
Measures of treatment effect
We will express the results as relative risk (RR) and 95% confidence
intervals (CI) for dichotomous outcomes, and weighted mean dif-
ference (WMD) and 95% CI for continuous outcomes. When
different scales are used to measure the same outcome (e.g. quality
of life) the scores will be standardised by dividing the reported
difference in means between the groups by the overall standard
deviation of outcome.
For scorings of thickness, pruritus, and pigmentation, we will try
to dichotomise the data, where possible, into the proportion of
people reporting no pruritus/pruritus or proportion of people with
no pigmentation or normal thickness. Both dichotomous and con-
tinuous measures will be taken into account where both are avail-
able. The result will also be expressed as number needed to treat
(NNT), where appropriate, with a 95% CI and the baseline risk
to which it applies.
Unit of analysis issues
Where there are multiple intervention groups within a trial, we
will make pairwise comparisons of similar interventions versus no
5
treatment, placebo, or any active control. If they exist, we will anal-
yse cross-over studies using appropriate techniques for paired de-
signs and will not be pooled with studies of other designs. We will
analyse internally controlled trials using appropriate techniques
for paired designs and these studies will not be pooled with stud-
ies of other designs. Quasi-randomised and non-randomised con-
trolled studies will be excluded but they will be listed and may be
discussed further.
Dealing with missing data
If participant dropout leads to missing data we will try to con-
duct an intention-to-treat analysis. We will contact trial authors or
sponsors of studies less than 15 years old to provide missing data
or statistics such as standard deviations. Data will be included for
analysis on those whose results are known (available case analy-
sis). For dichotomous outcomes, we will regard participants with
missing outcome data as treatment failures and include them in
the analysis. For continuous outcomes, we will use the last ob-
servation carried forward (LOCF) approach for participants with
missing data and include them in the analysis. The potential im-
pact of the missing data on the results will depend on the degree of
‘missingness’, the pooled estimate of the treatment effect, and the
variability of the outcome and will be considered in the interpre-
tation of the results. Where there is uncertainty, we will contact
trial authors for clarification.
Assessment of heterogeneity
We will assess statistical heterogeneity using I²statistic. If substan-
tial heterogeneity (I²statistic > 50%) exists between studies for the
primary outcome, we will explore the reasons for heterogeneity;
such as disease severity, dosage, and duration of treatment as well
as disease subtypes. If I²statistic is less than 80% we will synthesise
data using meta-analysis techniques.
REFERENCES
Additional references
Akay 2002
Akay A, Pekcanlar A, Bozdag KE, Altintas L, Karaman A.
Assessment of depression in subjects with psoriasis vulgaris
and lichen planus. Journal of the European Academy of
Dermatology and Venereology 2002;16:347–52.
Alabi 1981
Alabi GO, Akinsanya JB. Lichen planus in tropical Africa.
Tropical Geographical Medicine 1981;33:143–7.
Interventions for cutaneous lichen planus (Protocol)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Assessment of reporting biases
We will test publication bias by the use of a funnel plot when
adequate data are available for each active treatment component
used for cutaneous lichen planus.
Data synthesis
For studies with a similar active component, we will perform a
meta-analysis to calculate a weighted treatment effect across trials,
using a random-effects model. Where it is not possible to perform
a meta-analysis we will summarise the data for each trial.
Subgroup analysis and investigation of heterogeneity
We will perform further subgroup analysis according to disease
subtype, in patients with pigmented skin versus light coloured skin
if adequate information is given. Subgroup analysis of cutaneous
lichen planus patients with or without oral involvement will be
performed (if possible).
Sensitivity analysis
We plan to conduct sensitivity analyses to examine the effects of
excluding poor quality studies, defined as those with a moderate
or high risk of bias as described in the Cochrane Handbook of
Systematic Reviews of Interventions (Higgins 2008).
Other
Where there is uncertainty, we will contact authors for clarifica-
tion. A consumer, as an author, will read and edit all progress re-
ports throughout the review process to ensure the readability of
the final review.
ACKNOWLEDGEMENTS
We acknowledge the support of the Cochrane Skin Group in writ-
ing this protocol.
Boyd 1991
Boyd AS, Nelder KH. Lichen planus. Journal of the
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Chan 1999
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Pinkus 1973
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∗
Indicates the major publication for the study
7
APPENDICES

Appendix 1. Draft MEDLINE search strategy

1. randomized controlled trial.pt.
2. controlled clinical trial.pt.
3. randomized.ab.
4. placebo.ab.
5. clinical trials as topic.sh.
6. randomly.ab.
7. trial.ti.
8. 1 or 2 or 3 or 4 or 5 or 6 or 7
9. (animals not (human and animals)).sh.
10. 8 not 9
11. cutaneous lichen planus.mp. or exp Lichen Planus, Oral/
12. Lichen planus.mp. or exp Lichen Planus/
13. (annular or linear or hypertrophic).mp.
14. (vesiculobullous or erosive or ulcerative).mp.
15. (follicular or actinic or Blashkoid).mp. [mp=title, original title, abstract, name of substance word, subject heading word]
16. (zosteriform or inverse or bullous).mp. [mp=title, original title, abstract, name of substance word, subject heading word]
17. (atrophic or perforating or invisible).mp. [mp=title, original title, abstract, name of substance word, subject heading word]
18. Lichen planus pigmentosus.mp.
19. lichen planopilaris.mp.
20. 16 or 13 or 17 or 15 or 14
21. 12 and 20
22. 11 or 21 or 18 or 19
23. 22 and 10

HISTORY
Protocol first published: Issue 4, 2009

CONTRIBUTIONS OF AUTHORS
Draft the protocol (FG with contributions from others)
Search for trials (FG, AK)
Search grey literature (EL)
Identify relevant titles and abstracts from searches (FG, AK)
Obtain copies of trials (EL, CS, NB, JKG)
Select which trials to include (FG and AK; all authors for consensus)
Extract data from trials (FG and NB)
Enter data into RevMan (FG and AK)
Carry out the analysis (FG and AF)
Interpret the analysis (FK)
Draft the final review (FG, AF, AK, JKG with contributions from others)
Update the review (FG)
Interventions for cutaneous lichen planus (Protocol) 8
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DECLARATIONS OF INTEREST
None known

SOURCES OF SUPPORT

Internal sources
• Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Iran.

External sources
• No sources of support supplied

Interventions for cutaneous lichen planus (Protocol) 9

Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.