Dupilumab for the Treatment of Lichen Planus

To the Editor: Lichen planus (LP) is an inflammatory mucocutaneous disorder that primarily affects adults aged 30 to 60 years. 1 It can present across various regions such as the skin, scalp, oral cavity, genitalia, nails, and hair.It classically presents with pruritic, purple, polygonal papules or plaques.The proposed pathogenesis of this condition involves autoimmune destruction of epidermal basal keratinocytes. 2 Management involves a stepwise approach, beginning with topical therapies such as corticosteroids and phototherapy and proceeding to systemic therapy including oral corticosteroids and retinoids.3][4] Dupilumab is a biologic immunomodulator and antagonist to the IL-4Rα on helper T cells (T H 1).6][7][8][9] We present a case of dupilumab therapy for treatment-refractory LP.A 52-year-old man presented with a new-onset progressive rash over the prior 6 months.He reported no history of atopic dermatitis.The patient described the rash as "severely pruritic" with a numeric rating scale itch intensity of 9/10 (0 being no itch; 10 being the worst itch imaginable).Physical examination revealed purple polygonal scaly papules on the arms, hands, legs, feet, chest, and back (Figure 1).Three biopsies were taken, all indicative of lichenoid dermatitis consistent with LP.Rapid plasma reagin as well as HIV and hepatitis C virus serology tests were negative.Halobetasol ointment, tacrolimus ointment, and oral prednisone (28-day taper starting at 40 mg) all failed.Acitretin subsequently was initiated and failed to provide any benefit.The patient was unable to come to clinic 3 times a week for phototherapy due to his work schedule.