A 74-year-old white woman with type 2 diabetes mellitus, multinodular goiter, and lichen planus of the oral mucosa was treated with interferon alfa for chronic hepatitis C (genotype 1a). During 4 weeks of systemic subcutaneous interferon alfa therapy (5 × 106 U, 3 times per week), the preexisting erosive mucosal lichen planus was exacerbated such that nonhealing erosions developed in the entire oral cavity including the mucous membrane of the tongue, cheeks, and gingiva. Bacterial, mycotic, and viral infections were excluded. Interferon alfa treatment was discontinued, and the patient underwent a 2-month topical treatment with ointments containing 0.05% clobetasol propionate, but the oral lesions did not ameliorate. Within 8 weeks the patient lost 5.4 kg because of painful erosions and secondary anorexia. Therapies with systemic retinoids or thalidomide were contraindicated because of type 4 hyperlipoproteinemia and diabetic polyneuropathy. Systemic therapy with glucocorticosteroids (0.5 mg/kg per day) for erosive lichen planus had failed in 1993 and was not restarted in view of the patient's diabetes.
Walchner M, Messer G, Salomon N, Plewig G, Röcken M. Topical Tetracycline Treatment of Erosive Oral Lichen Planus. Arch Dermatol. 1999;135(1):92-93. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-1-dlt0199