Treatment of erosive vulvovaginal lichen planus with methotrexate

We report the successful treatment of severe long-standing erosive vulvovaginal lichen planus in four adult female patients using 2.5-7.5 mg of oral methotrexate once weekly in conjunction with topical clobetasol dipropionate 0.05% ointment and tacrolimus 0.03-0.10% ointment. All cases experienced improvement in symptoms and healing of lesions within 4-8 weeks. Methotrexate was well tolerated and no adverse events have been observed in any of the patients at follow up 4-6 months later.