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Mark Bornfeld
Mark Bornfeld, Dentist (DDS)
Category: Health
Satisfied Customers: 5731
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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I have been suffering from a skin condition known as lichen

Resolved Question:

I have been suffering from a skin condition known as lichen planus for the last 2 years.
Lichen planus mainly causes an itchy skin rash. It affects a few parts of my body such as my mouth, genitals, nails and hair. In most cases the condition goes within 6-18 months. Treatment, commonly with a steroid cream or ointment, often eases the itch and may reduce the rash until the condition clears but this is the only treatment the medicine can offer at the moment and in my case it didn’t work.
I have also tried many other alternatives such as Chinese remedies, Aloe Vera treatments and seek advice from a Health specialist but after 2 years of trying new remedies my condition has remained the same. It does affect a lot my health and of course my love life as both my mouth and genitals are very painful. The constant itching is very irritating and sitting down position often unbearable. The pain also wakes me up at night.
I would like to thank you in advance should you have any recommendation on this matter.
Submitted: 5 years ago.
Category: Health
Customer: replied 5 years ago.

Thank you for your answer. My GP advised me against the treatment your refer to for the same reason you mentioned. He also admited that there was nothing the Genearl Medicine could do to help me that is why he didn't see any objection for me to try other alternatives. Being French, I also went to see a few doctors and dermatologist in France but I got the same answers.

Is there any solutions you could advise without having to use something with risk of cancer?

Thank you in advance.

Expert:  replied 5 years ago.
Dear ,

Keep in mind that because the immune system is the very thing that causes lichen planus, and that the immune system is also our primary defense against cancer and infection, that the treatment of lichen planus itself always incurs some increased risk of both cancer and infection. This is the unavoidable problem when treating auto-immune disease (not just lichen planus, but the others as well, including rheumatoid arthritis). Corticosteroids have some powerful side-effects as well, and these medications are still used if the benefits justify the risks.

I don't know the status of tacrolimus in the UK or France, but here in the U.S., it is not officially approved for use in oral lichen planus. However, the oral pathologists here use it "off label"-- that is to say, in situations where it is not officially approved-- because it seems to work so much better than the approved first-line therapies for lichen planus.

Tacrolimus and similar medications such as pimecrolimus have indeed been found to present some slight increased risk of lymphoma and other cancer. However, the legal climate in the U.S. (and quite possibly your locale) mandates that any risk of cancer, no matter how slight, be conspicuously posted on the medication packaging as a black box warning. This can be quite daunting to the doctor, who might otherwise be willing to weigh the slight risk of a medication against the considerable probability of helping his patient.

It all comes down to whether your symptoms are sufficiently troubling to justify the slight risk of more powerful and effective medication. This is a decision that only you can make, with guidance from your doctors. However, you should know that some of your doctors may discourage you from taking the medication because they are reluctant to assume the liability, and not because the medication would not help you.

I am not knowledgeable of the alternative therapies that may help you, but you have clearly explored some of them already. Of the more mainstream therapies, there are only the immunosuppressants. If you are willing to explore the choices, then tacrolimus is really the only way to go after using steroids.

Good luck!
Mark Bornfeld, Dentist (DDS)
Category: Health
Satisfied Customers: 5731
Experience: Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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