From the Guidelines
Lichen planus is not a form of eczema, but rather a distinct autoimmune condition with its own set of characteristics and treatment approaches. The treatment for lichen planus typically includes topical corticosteroids as first-line therapy, with options like clobetasol 0.05% ointment applied twice daily for 2-4 weeks, as recommended by the NCCN guidelines 1. For severe or widespread cases, oral corticosteroids (prednisone 30-60mg daily for 2-4 weeks with tapering), oral antihistamines for itching, and phototherapy may be used.
Some key differences between lichen planus and eczema include:
- Characteristic flat-topped, purple, polygonal papules often with white lacy patterns (Wickham's striae) in lichen planus, versus red, scaly, and sometimes weeping patches in eczema
- Lichen planus is thought to be an autoimmune condition where T-cells attack the skin's basal layer, whereas eczema is driven by skin barrier dysfunction and inflammation
- Lichen planus is typically self-limiting, resolving within 1-2 years (though oral forms may persist longer), while eczema tends to be chronic with flare-ups throughout life
Treatment approaches differ between the two conditions, with lichen planus often requiring stronger immunosuppressive therapies for shorter periods, while eczema management focuses on long-term barrier repair with moisturizers alongside anti-inflammatory treatments. According to a recent study, topical steroids were the most frequently used treatments for the management of lichenoid dermatitis (81%) 1. Other treatments included oral antihistamines, oral steroids, acitretin, intralesional triamcinolone, narrow-band UVB, and other unspecified nonsteroidal treatment.
In terms of specific treatment options, high-potency topical steroids (eg, clobetasol 0.05% or fluocinonide 0.05% [cream or ointment]) or tacrolimus (0.1% ointment) are recommended for all grades of lichen planus and lichenoid diseases 1. Additionally, oral antihistamines, prednisone, and narrow-band UVB phototherapy (if available) are recommended for the treatment of lichen planus 1.
From the Research
Lichen Planus vs Eczema
- Lichen planus is a chronic-relapsing inflammatory skin disease, distinct from eczema 2
- It is characterized by a lichenoid inflammatory infiltrate and vacuolar degeneration of the basal layer of the epidermis 3
Treatment of Lichen Planus
- Topical corticosteroids, such as clobetasol propionate 0.05%, are effective in treating cutaneous lichen planus 4
- Narrowband UVB (NBUVB) phototherapy has been shown to be effective in treating generalized lichen planus, with higher patient satisfaction compared to systemic corticosteroids 5
- Systemic corticosteroids, immunosuppressants, and biologics may also be used as treatment options 6, 3
Differences in Treatment from Eczema
- While both lichen planus and eczema may be treated with topical corticosteroids, the treatment approach for lichen planus often involves a more comprehensive approach, including phototherapy and systemic medications 5, 6
- The treatment of lichen planus is often individualized, taking into account the type, extent, and severity of the disease 6
Treatment Modalities
- Topical treatments, including topical corticosteroids and calcineurin inhibitors, are commonly used to treat lichen planus 2
- Phototherapy, including NBUVB, may be used to treat generalized lichen planus 5
- Systemic medications, including corticosteroids, immunosuppressants, and biologics, may be used to treat more severe cases of lichen planus 6, 3