THERAPEUTIC HOTLINE: SHORT PAPERS
Bacillus Calmette-Guerin, polysaccharide nucleic acid in the
treatment of cutaneous and oral lichen planus
Mohamad M. Nasr
Howyda M. Ebrahim
Fathia M. Khattab
Ayman M. Marei
Dermatology, Venereology and Andrology,
Faculty of Medicine, Zagazig University,
Microbiology, Faculty of Medicine, Zagazig
University, Zagazig, Egypt
Howyda M. Ebrahim, Faculty of Medicine,
Zagazig University, Zagazig, Egypt.
The aim of this study was to evaluate the safety and efficacy of Bacillus Calmette-Guerin, polysac-
charide nucleic acid (BCG-PSN) therapy in the treatment of oral and cutaneous LP. Twenty-four
LP patients were included in this study and classified randomly into; Oral LP group (OLP), 11
patients and Cutaneous LP group (CLP), 13 patients. All patients received intradermal injections of
BCG-PSN, twice weekly for three weeks. Patients with complete response were followed up for 3
months. The assessment in OLP was based on the reduction in the treated area, (Reticulation/Ery-
thema/Ulceration) REU scoring system and numerical rating scale (NRS). CLP evaluated by the
response to treatment as (complete, partial and no response) and visual analogue scale (VAS).
There were highly significant differences in the diminution of lesion areas (p < .006), NRS scores
(p < .001), REU score (p < .011), and VAS (p < .001) after treatment. The majority of patients
achieved complete response after 3-week management. The BCG-PNS is safe and effective in the
treatment of oral and cutaneous LP.
Bacillus Calmette-Guerin, lichen planus, polysaccharide nucleic acid
Lichen planus (LP) is papulosquamous eruption of the skin and mucous
membranes. The pathogenesis of LP was suggested to be T-cell-
mediated autoimmune disease (Gupta, Chaudhari, & Gupta, 2013). In
cutaneous LP, pruritus is the most troublesome symptom of the dis-
ease; it ranged from unpleasant sensation to severe itching. Oral lichen
planus (OLP) is chronic inflammatory disease with multiple clinical man-
ifestations. OLP are asymptomatic but erosive types may causes sore-
ness or severe pain. Erosive OLP or generalized LP may have poor
quality of life (Manousaridis, Manousaridis, Peitsch, & Schneider, 2013).
Treatment of LP includes topical treatments, phototherapy and sys-
temic corticosteroids (Wang, 2016). Bacillus Calmette-Guerin polysac-
charide nucleic acid (BCG-PSN) has the immune function of BCG
vaccine without any risk of infection. It is protein fraction extracted
from BCG with higher quality and fewer side effects as redness or
swelling at the injection site (Bascones-Martinez, Mattila, Gomez-Font,
& Meurman, 2014). BCG is live attenuated bovine strain of tuberculosis
(Li, Cao, & Niu, 2013). BCG has many adverse effects as lupus vulgaris,
keloid scarring, suppurative lymphadenitis, and disseminated infection.
BCG-PSN regulates subsets of T cells, induces T helper type-1 immu-
nity (Th1) and enhancing the cellular immunity (Chun, 2010). BCG-PSN
had therapeutic benefits for treatment of several diseases as idiopathic
urticaria, (Li, Cao, & Niu, 2013) alopecia areata (Chun, 2010), melanoma
(Sloot, Rashid, Sarnaik, & Zager, 2016), warts (Zuo, Huang, & Liao,
2004), recurrent oral aphthosis (Sharquie & Hayani, 2005) and vitiligo
(Zhan, Xiong, & Wang, 2014).
PATIENTS AND METHODS
This randomized study was carried out at the outpatient clinics of
Dermatology, Venereology and Andrology Department, Faculty of
Medicine, Zagazig University Hospitals during the period from July
2015 to July 2016. It was approved by the Institutional Review Board
(IRB) at Zagazig University. Written informed consent was obtained
from all patients.
Dermatologic Therapy. 2018;31:e12591.
2018 Wiley Periodicals, Inc.
Received: 15 March 2017
Revised: 22 August 2017
Accepted: 9 November 2017