Metronidazole reasonable treatment option for patients with symptomatic oral lichen planus

The researchers suggested metronidazole to be a reasonable option given its efficacy, mild side effect profile, and less immunosuppressive nature as compared to alternative systemic treatment options.

At least partial response was seen in 60.0% of the patients treated with metronidazole 500 mg twice daily, with complete response noted in 33.3% of the patients.

Lichen planus is an inflammatory dermatosis with mucosal variants, including oral lichen planus. OLP has relapsing chronic courses and may have a significant impact on quality of life. Following approval from the FDA's Institutional Review Board (IRB), Alison N Hollis, University of North Carolina at Chapel Hill, North Carolina, USA, and colleagues analyzed metronidazole's efficacy as a treatment for oral lichen planus by retrospective chart review of patients at the institution over 10 years with a diagnosis of OLP. The study included patients with concomitant use of topical treatments.

Thirty patients with oral lichen planus were treated with metronidazole 500 mg twice daily. Most patients (n=18, 60.0%) showed improvement with metronidazole, including 10 (33.3%) with complete resolution of symptoms.

The results are limited by the nature of a retrospective review study with a relatively small cohort treated with metronidazole.

Despite multiple limitations of the study, the researchers conclude, "oral metronidazole may be a relatively well-tolerated treatment option for patients with OLP who have failed treatment with first-line topical corticosteroids."

"Given the mild side effect profile, efficacy, and the less immunosuppressive nature of metronidazole compared to alternative systemic treatment options, metronidazole is a reasonable option to try in patients with symptomatic oral lichen planus who have failed topical treatment options," they wrote.

Reference:

Hollis, A. N., Myers, E. L., & Culton, D. A. A retrospective cohort study on the efficacy of metronidazole in oral lichen planus. Clinical and Experimental Dermatology. https://doi.org/10.1093/ced/llad268