A prospective cohort study to determine the reduction of Itch Severity Score (ISS) in Lichen Planus treated with low molecular weight heparin in a tertiary care centre

Lichen planus (LP) is a T cell mediated disorder that affects the skin and mucosa, exhibiting distinct morphologic and histopathological features. The term Lichen is derived from Greek word (Leichen), which means tree moss. It is a self-limiting disease that affects mostly middle-aged people. It can involve the skin, mucous membrane, hair and nails. Oral lichen planus can occur with or without skin lesions. The typical lesion of lichen planus is pruritic, polygonal, faintly erythematous to violaceous flat topped papule distributed over the flexors. Other morphological types include hypertrophic, atrophic, vesicular and bullous lesions. Koebner‘s phenomenon may be seen. Many causes have been implicated. Although spontaneous regression can occur in a few patients itching can be very troublesome. Various treatment options are available in the form of topical and systemic therapy. Low dose of low molecular weight heparin (Enoxaparin) was first used by Hodak et al in 1988 at the dose of 3 mg in the treatment of lichen planus. Enoxaparin is a disaccharide moiety derived from heparin by a method of polymerization. Unlike heparin it is devoid of anticoagulant property. Its immunomodulatory and anti proliferative properties enables its use in lichen planus. Enoxaparin inhibits the expression of heparanase enzyme (endoglycosidase) that is synthesized by CD4 cells. T lymphocytes heparanase cleaves the heparin sulfate side chains of the extracellular matrix allowing the T cell to penetrate into subendothelial basal lamina of the epidermis to reach the target tissues. Enoxaparin also inhibits delayed type hypersensitivity response. It also acts by inhibiting the key pro- inflammatory cytokine tumour necrosis factor alpha. Its anti-pruritic effect is evident within a week of onset of the treatment. In our study Enoxaparin was given at a dose of 4mg subcutaneously every week to 100 patients for 9 weeks and the reduction in ISS was determined. The percentage of reduction was also analysed.