Optimization of therapy in patients with lichen ruber planus by means of cranial electrotherapy stimulation

Rationale: Taking into account the significance of psychogenic factor in the onset of lichen planus, its correction is advisable. Transcranial electric stimulation is promising, given its autonomous regulating, analgesic, antipruritic, reparative and regenerative, and immunomodulatory effects, in addition to the anti-stress one. Aim: To assess the effectiveness of the combination therapy including cranial electrotherapy stimulation (CES) with lichen ruber planus. Materials and methods: This was an open label, prospective, comparative study in 61 patients with common typical form of lichen ruber planus (39 (63%) women and 22 (37%) men) aged 18 to 74 years (mean age 41 14.29 years). The duration of the disease was 11.88 10.15 months (range, 1 to 42 months). The patients were adaptively randomized into two groups of similar gender distribution, age, and disease duration. The patients in the comparison group (n = 30) were treated conventionally in accordance with the Federal Clinical Guidelines (chloroquine, hydroxyzine, topical corticosteroids). The main group (n = 31) was administered similar therapy; however, instead of hydroxyzine, CES was performed. The duration of in-patient treatment in both groups was 14 days, with the follow-up lasting for up to 3 months. The results of treatment were assessed by dynamics of pathological changes of the skin (Index of Lichen Planus, ILP), impact of dermatosis on various domains of the patients life (Dermatology Life Quality Index, DLQI), changes in psychological status (Hamilton Anxiety Scale and Hamilton Depression Scale). In addition, the impact of pruritus on the patients' daily activities was assessed by Behavioral Rating Scores questionnaire (BRS). Results: At baseline, there were no significant differences between the groups in ILP (p = 0.801), DLQI (p = 0.501), BRS (p = 0.521), Hamilton Anxiety Scale (p = 0.301), and Hamilton Depression Scale (p = 0.493). At the end of treatment, ILP in the CES group decreased 3.25-fold (p 0.001), whereas in the group treated with conventional therapy the decrease was 2.1-fold (p 0.001); DLQI decreased 2.5-fold (p 0.001) and 1.8-fold (p 0.001), respectively. The corresponding decreases of Hamilton Anxiety Scale in the treatment groups were 2.3-fold and 1.3-fold, respectively, and those in Hamilton Depression Scale 2-fold and 1.6-fold, respectively (all p 0.001). In addition, statistically significant intergroup differences were found for ILP (p = 0.04), DQLI (p 0.001), Hamilton Anxiety and Depression scale scores (p = 0.021 and p = 0.006, respectively). As for the BRS changes, in both groups there was an equally significant (p 0.001) decrease, but the intergroup differences were not statistically significant (p = 0.485). Conclusion: The proposed combination therapy of patients with lichen ruber planus including CES has led to a decrease in the indicators of the skin process activity within a shorter time period than in the patients under conventional treatment. In addition, the patients of both groups showed normalization of psychological parameters and improvement in dermatological quality of life; however, only in the CES group, these changes were significant.