From the Guidelines
Lichen planus pigmentosus should be treated with high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05% cream or ointment, or tacrolimus 0.1% ointment, as recommended by the NCCN guidelines 1.
Treatment Options
- High-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05% cream or ointment, are effective for treating lichen planus pigmentosus 1.
- Tacrolimus 0.1% ointment is a recommended alternative, especially for sensitive areas 1.
- Oral antihistamines, prednisone, and narrow-band UVB phototherapy may also be considered for treatment 1.
Important Considerations
- The choice of treatment formulation (gel, solution, cream, lotion, or ointment) depends on the affected area, with gel considered for mucosal disease, solution for scalp disease, and cream/lotion/ointment for all other affected areas 1.
- Treatment outcomes may vary, and pigmentation often persists despite therapy.
Patient Education
- Patients should be educated on the importance of sun protection, including applying broad-spectrum SPF 30+ sunscreen daily and wearing protective clothing.
- Lichen planus pigmentosus is typically a benign but chronic condition, requiring consistent treatment and sun protection for best results.
From the Research
Lichen Planus Pigmentosus Overview
- Lichen planus pigmentosus (LPP) is a rare variant of lichen planus, characterized by the insidious onset of violaceous, brown, or grayish patches on photo-distributed areas 2.
- It is considered a rare variant of lichen planus (LP) and is characterized by acquired dark brown to gray macular pigmentation located on sun-exposed areas of the face, neck, and flexures, commonly found in dark-skinned patients 3.
Treatment Options
- Treatment for LPP is difficult and consists of avoidance of triggers and topical and systemic medications in order to stop the inflammatory reaction and reduce pigmentation, improving aesthetic appearance and quality of life 3.
- Topical steroids and calcineurin inhibitors are the current first-line therapies for lichen planus, while for other therapies the strength of recommendation is not so evident 4.
- There is limited data regarding the efficacy of treatments for LPP, and larger randomized, controlled trials are still warranted to establish the exact benefits of other topical treatments, phototherapy, immunosuppressant and new immunomodulators for an optimized treatment of LP 4.
Associated Factors
- LPP has been associated with hepatitis C virus, sun exposure, and contactants such as mustard oil and nickel 3.
- LPP-inversus affects fair and dark skin, predominantly involving flexural and intertriginous areas, while sun-exposed areas are spared; friction is an associated trigger 3.
- LPP can present concomitantly with other variants of LP such as frontal fibrosing alopecia, as well as endocrinopathies, and autoimmune diseases 3.
Comparison of Treatments
- A study compared the safety and efficacy of topical clobetasol propionate and tacrolimus ointment in the treatment of cutaneous lichen planus, and found that both treatments were effective, but clobetasol propionate was more effective 5.
- However, tacrolimus may be preferred before topical corticosteroids for lesions on the face, neck, and intertriginous regions of the body, which are sensitive to the cutaneous adverse effects of topical corticosteroids 5.