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).