In this issue of the Archives, Paslin1 describes three patients in whom a remission of lichen planus occurred as a consequence of short-term cyclophosphamide therapy. It was obviously a small, open-label drug trial, and therefore, it should be interpreted carefully. As reviewed by Paslin, lichen planus has been theorized to be immunologically mediated by T lymphocytes. If so, it is not surprising that the condition responds dramatically to immunosuppressive therapy.
Many diseases in dermatology are mediated primarily or secondarily by the immune system; others are hyperproliferative and could therefore be expected to respond similarly to the cytotoxic effects inherent in many immunosuppressive agents. In some diseases, the efficacy of immunosuppressive agents is relatively undisputed and may save lives. Examples include cyclophosphamide and azathioprine therapy for pemphigus2; methotrexate3 and hydroxyurea4 plaque and pustular therapy for psoriasis; and cyclophosphamide and chlorambucil therapy for Wegner's granulomatosis.5 Immunosuppressive
Bell I, Weinstein GD. The Use and Abuse of Immunosuppressive Agents in Dermatology. Arch Dermatol. 1985;121(2):195-196. doi:10.1001/archderm.1985.01660020053016