ABSTRACT The current absence of gold-standard or all-aspect favorable therapies for COVID-19 renders a focus on multipotential drugs proposed to prevent or treat this infection or ameliorate its signs and symptoms vitally important. The present well-designed randomized controlled trial sought to evaluate the efficacy and safety of N-acetylcysteine as adjuvant therapy in hospitalized Iranian patients with COVID-19. Four different diets in 60 patients include; Kaletra (lopinavir/ritonavir) + hydroxychloroquine with/without N-acetylcysteine (600 mg TDS) and atazanavir/ritonavir + hydroxychloroquine with/without N-acetylcysteine (600 mg TDS), were administered in the study. At the end of the study, a further decrease in C-reactive protein was observed in groups with N-acetylcysteine (P =0.008), and no death occurred in the atazanavir/ritonavir + hydroxychloroquine + N-acetylcysteine group, showing that the combination of these drugs may reduce mortality. A significant rise in O2 saturation was observed in atazanavir/ritonavir+hydroxychloroquine+N-acetylcysteine group (P <0.05). Accordingly, oral or intravenous N-acetylcysteine, may enhance O2 saturation, blunt the inflammation trend (by reducing C-reactive protein), and reduce mortality in hospitalized patients with COVID-19. The N-acetylcysteine could be more effective as prophylactic or adjuvant therapy in stable and non-severe cases of COVID-19 with a particularly positive role in the augmentation of O2 saturation and faster reduction of the CRP level and inflammation.

Introduction:Lichen Planus is a skin disease that can also affect the mucous membranes and nails (1, 2). The skin manifestations of this disease are multiple purple papules often accompanied by itching (3). The mucosal involvement of this disease is known as mucosal erosions that often involve the oral mucosa and genital area (4).One of the rare types of this skin disease is called ulcerative lichen planus, which presents as chronic ulcers resistant to treatment, associated with pain and many disabilities for patients (5, 6). The involvement of the soles of the feet is one of the most significant areas affected by ulcerative lichen planus. Despite several treatment options having been studied in the past, treating plantar ulcerative lichen planus remains a challenge for dermatologists (4-8).Tofacitinib, a Janus Kinase inhibitor, has a special place in the treatment of inflammatory diseases in medicine (9). Recently, studies have shown its effectiveness in treating various skin diseases such as psoriasis, alopecia areata, vitiligo, and atopic dermatitis (10). In recent studies, the effectiveness of this drug in treating certain types of lichen planus has been mentioned, including lichen planopilaris and erosions of the oral mucosa (9, 11).In this article, we presented a case of plantar ulcerative lichen planus that was initially resistant to treatment but exhibited a remarkable response upon being treated with oral tofacitinib. In addition, we conducted a comprehensive review of literature on the efficacy of tofacitinib in treating various types of lichen planus lesions, while also discussing other proposed treatments for plantar ulcerative lichen planus.