INTRODUCTION
Oral lichen planus (OLP) is an inflammatory mucosal disease, mediated by a predominantly T-cell lymphocytic response at the dermoepidermal junction.1 With a global prevalence of approximately 1%, OLP can have a range of effects including significant chronic pain and sensitivity to the oral mucosa, and reduction in quality of life.1 OLP classically presents bilaterally in the oral buccal mucosa as reticular white patches with or without ulcers.1-2 The entire mechanism of OLP is not understood, but largely CD8+ cytotoxic and CD4+ Th1 T-cells and potentially Th9, Th17, and Tregs are thought to play a role in the T-cell mediated inflammatory response.1 Factors including hepatitis C viral infection, drugs, and other variables can contribute to the development of OLP.2 OLP can be challenging to treat, often managed by a variety of methods, predominantly treated with topical corticosteroids, topical calcineurin inhibitors, retinoids, and immunosuppressants.2 Recently, the emergence of JAK inhibitor use in dermatology has been a helpful intervention in previously difficult-to-treat conditions.3 Upadacitinib is a JAK-1 selective inhibitor used primarily in rheumatoid arthritis, that has shown promise in treating a variety of dermatologic diseases3; however, it has only been cited twice in the literature to our knowledge as a treatment for OLP.4,5 Our case documents a 70% improvement within 1 month of use of upadacitinib in a chronic, treatment-resistant case of OLP.
CASE
A 65-year-old female presented to the clinic with uncontrolled OLP. The patient has a history of OLP previously diagnosed by oral surgery via brush biopsy technique. Her medications include trazodone and triamterene-hydrochlorothiazide. Previously used medications and approaches included nystatin oral suspension, avoidance of metal utensils, triamcinolone 10 mg/cc intralesional injections, triamcinolone 0.1% dental
paste and ointment, betamethasone cream, prednisone taper, and over-the-counter methods to alleviate her condition without success. The rash presented as white reticulated patches in the bilateral buccal mucosa. No ulcers were present. The rash was located on the bilateral vestibular mucosa, mandibular gingiva, palate, bilateral vestibular buccal cheek (Figure 1, Figure 2). No genital involvement was noted. Her condition was extensive, and her pain and irritation were severe, interfering with her ability to eat. She was treated with fluoride-free toothpaste, a topical mixture of viscous lidocaine, diphenhydramine, and Maalox Advanced 200-200-20 mg/5 mL oral suspension, and triamcinolone 5 mg/mL intralesional injections.
