Efficacy And Safety Of Low-Dose Methotrexate In Generalized And Recalcitrant Lichen Planus: A Retrospective Study At A Tertiary Care Center

Introduction: Methotrexate (MTX) acts by suppressing multiple immune pathways involved in the pathogenesis of lichen planus (LP). Trials assessing the efficacy and relapse rates of methotrexate in LP are lacking. Objectives: Our objective was to analyze the efficacy and safety of low-dose methotrexate in generalized and recalcitrant LP patients retrospectively and to assess the relapse rates in patients after stopping MTX therapy. Methods: We analyzed clinical and therapeutic details of LP patients treated with low-dose MTX at our center. The cumulative dose and duration of MTX was calculated, and the time to achieve disease control was noted. We analyzed duration of remission and time after which recurrences were seen post-treatment. Results: Records of 42 generalized and recalcitrant LP patients treated with MTX were analyzed. The starting dose of MTX was 7.5 mg (n=7) or 10 mg (n= 35) once weekly, increased to 10/15 mg weekly in patients with inadequate response. Ten patients were lost to follow-up. Complete resolution was achieved in 30/32 (93%) patients within a mean duration of 14.76 weeks (4-32 weeks), and the cumulative dose of MTX to achieve remission was 153.58 mg (50-375 mg). Only minor side effects were noted in 12/32 (37.5%) patients, and none required treatment discontinuation. The mean duration of remission was 29.43 months (5-60 months). Conclusion: MTX demonstrated high efficacy and a good safety profile in extensive cutaneous LP and may be a safer alternative to steroids for this condition.