Introduction:
Lichen planus (LP) is a chronic disease that can affect the skin, nails,
oral and genital mucosa, hair, scalp, conjunctiva, larynx, and pharynx
that is inflammatory and autoimmune. The onset is typically acute,
affecting the wrist, forearm, and leg flexor surfaces. Lacy, reticular,
white lines known as Wickham striae frequently cover the
lesions.1 It could be idiopathic, or caused by certain
medications or related to hepatitis C- virus infection, and other
autoimmune diseases.2 The lichenoid response, which
may result in basal cell damage, may lead to immune responses to unknown
external or self-modified antigens by T-cells. Keratinocytes cause
damage by transmitting foreign or modified self-antigens on
surfaces.3
A strong pro-inflammatory cytokine that causes acute process reactions
is a tumor necrosis factor-alpha (TNF-α). It plays apart in cell
proliferation, differentiation, apoptosis, immunity, and inflammation
control. Also, it has a pivotal role in the growth and differentiation
of different cell types and has antitumor activity, TNF-α, therefore,
has an essential role in the local and systemic immunopathogenesis of
LP.4
It has been reported that the serum levels of TNF-α were reported to be
significantly increased in patients with LP, so TNF-α could play a
crucial role in pathogenesis of LP.5
Narrow Band-Ultraviolet B (NB-UVB) may be an essential alternative
therapy for lichen planus. NB-UVB reduces the cells of langerhans and
causes cytokines and neuropeptides to develop and secrete. NB-UVB
induces the production of anti-inflammatory cytokines and alters the
expression of adhesion molecules which suppress TNF-α mediated
inflammation.6 Methotrexate (MTX) is an
anti-metabolite utilized to treat several autoimmune inflammatory
disorders. It suppresses the replication and function of T and B
lymphocytes. It has both immunomodulatory and anti-inflammatory effects.
These influences are mediated by the secretion of adenosine at sites of
inflammation by fibroblasts and endothelial cells. Other potential
influences of MTX activity in cutaneous disorders are inhibition of
chemotaxis, suppression of monocyte⁄macrophage stimulation, and
suppression of histamine release from basophils.7 It
has been found that MTX was an effective therapy for patients with
LP.8,9
This study aimed to assess the clinical efficiency of NB-UVB
phototherapy and MTX therapy and their effects on serum TNF-α in
patients with cutaneous lichen planus (CLP).