From the Guidelines
The initial treatment for both lichen planus and eczema typically involves high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05%, as recommended by the NCCN guidelines 1. When considering treatment options, it's essential to prioritize the most recent and highest quality studies, which in this case, supports the use of high-potency topical steroids for all grades of lichen planus and lichenoid diseases. Some key points to consider when treating lichen planus and eczema include:
- Using gel for mucosal disease, solution for scalp disease, and cream/lotion/ointment for all other affected areas 1
- Recommending oral antihistamines, prednisone, and narrow-band UVB phototherapy (if available) for more severe cases 1
- Avoiding triggers such as harsh soaps, certain fabrics, and known allergens is crucial for eczema management
- Wet wrap therapy can provide additional relief for severe eczema flares
- Referral to a dermatologist for additional therapies like systemic medications or phototherapy should be considered if symptoms don't improve within 2-4 weeks, or if the affected areas include mucous membranes or cover large body areas. It's also important to note that while older studies, such as those from 1995 1, provide some guidance on the management of eczema, they may not reflect the most current and effective treatment approaches, and therefore, should not be prioritized over more recent and higher quality studies like the NCCN guidelines 1.
From the Research
Lichen Planus and Eczema Treatment
- The initial treatment for lichen planus and eczema typically involves the use of high-potency topical corticosteroids, such as clobetasol propionate 2, 3, 4.
- Topical corticosteroids are effective in reducing inflammation and pruritus associated with lichen planus and eczema 2, 4.
- In addition to topical corticosteroids, topical tacrolimus may also be used to treat vulvovaginal lichen planus 2.
- For severe, widespread lichen planus involving oral, cutaneous, or genital sites, systemic corticosteroids may be considered 2.
- Referral to a dermatologist for systemic therapy with acitretin or an oral immunosuppressant may be necessary for patients with severe lichen planus that does not respond to topical treatment 2.
- European guidelines recommend the use of topical steroids and calcineurin inhibitors as first-line therapies for lichen planus, while other therapies have a lower strength of recommendation due to limited evidence 5, 6.