From the Guidelines
The best initial treatment for oral lichen planus is high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05% cream or ointment, as recommended by the NCCN guidelines. According to the NCCN guidelines 1, these treatments are recommended for all grades of lichen planus and lichenoid diseases. The application of these topical steroids should be tailored to the specific area of the mouth affected, with gels considered for mucosal disease and creams or ointments for other areas.
- Key points to consider when using topical corticosteroids for oral lichen planus include:
- Applying a pea-sized amount directly to the affected area 2-3 times daily for 2-4 weeks, then tapering to once daily for another 2-4 weeks if symptoms improve
- Using a clean finger to press the medication against the lesion for 2-3 minutes, and advising patients to avoid eating or drinking for 30 minutes afterward
- Considering alternative formulations, such as triamcinolone acetonide 0.1% in dental paste (Orabase) for gingival lesions, or corticosteroid mouth rinses like dexamethasone 0.5 mg/5mL solution for widespread lesions
- It is essential to note that while other studies, such as the British Association of Dermatologists' guidelines 1, provide additional information on the management of lichen sclerosus, the NCCN guidelines 1 offer the most recent and relevant recommendations for oral lichen planus.
- Patients should maintain good oral hygiene, avoid spicy or acidic foods that may exacerbate symptoms, and have regular follow-ups to monitor response and potential side effects. For cases resistant to topical steroids, second-line treatments include topical calcineurin inhibitors or systemic medications.
From the Research
Treatment Options for Oral Lichen Planus
- Topical corticosteroids, such as clobetasol propionate, are commonly used to treat oral lichen planus (OLP) 2, 3, 4, 5
- Tacrolimus 0.1% ointment or cream has been shown to be an effective alternative to topical steroids in the treatment of OLP 2, 6
- Systemic corticosteroids, such as prednisone, may be used to control acute presentations of OLP, but are not recommended as a first-line treatment due to potential side effects 4, 5
Efficacy of Treatment Options
- A study comparing topical tacrolimus and clobetasol found that tacrolimus resulted in a higher complete response rate (70% vs 40%) and greater patient-reported improvement 2
- Another study found that topical clobetasol propionate 0.05% was effective in reducing symptoms and clinical appearance of OLP, with 87% of patients showing improvement after 2 months of therapy 3
- A comparative study of systemic and topical corticosteroid treatment found that topical treatment was as effective as systemic treatment in achieving complete remission of signs and symptoms, with fewer side effects 4