What is the treatment for lichen planus on the legs and arms?

From the Guidelines

Treatment for lichen planus on the legs and arms should begin with high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05%, or tacrolimus 0.1% 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 choice of formulation, such as cream, lotion, or ointment, depends on the affected area, with cream or ointment being suitable for the legs and arms.

Some key points to consider when treating lichen planus on the legs and arms include:

• Using high-potency topical steroids or tacrolimus 0.1% ointment as first-line treatment
• Considering oral antihistamines, such as hydroxyzine or cetirizine, to manage itching
• Using narrow-band UVB phototherapy, if available, for more severe cases
• Avoiding scratching and keeping the affected areas moisturized with fragrance-free emollients

It's worth noting that while acitretin has been shown to be effective in treating lichen planus, particularly in severe cases 1, the most recent and highest quality evidence recommends high-potency topical steroids or tacrolimus 0.1% ointment as the initial treatment. Therefore, high-potency topical steroids or tacrolimus 0.1% ointment should be the primary treatment option for lichen planus on the legs and arms, with other treatments being considered for more severe or resistant cases.

From the Research

Treatment Options for Lichen Planus on Legs and Arms

• High-potency topical corticosteroids are considered first-line therapy for all forms of lichen planus, including cutaneous lesions on the legs and arms 2.
• Topical tacrolimus may also be an effective treatment for cutaneous lichen planus, although its use is more commonly associated with vulvovaginal lichen planus 2.
• Systemic corticosteroids should be considered for severe, widespread lichen planus involving multiple sites, including the legs and arms 2.
• For patients with severe lichen planus that does not respond to topical treatment, referral to a dermatologist for systemic therapy with acitretin or an oral immunosuppressant may be necessary 2.

Alternative Therapies

• Pimecrolimus, a topical non-steroidal drug, has been proposed as a potential treatment for lichen planus, although its use is more commonly associated with atopic dermatitis 3.
• Hydroxychloroquine and methotrexate have been shown to be effective in treating severe and recalcitrant lichen planus, with response rates of 61% and 42%, respectively 4.
• Intramuscular triamcinolone (IM TAC) has been found to be a highly effective treatment for severe or refractory lichen planus, with a response rate of 79% 4.

Treatment Approach

• An individualized treatment approach is recommended, taking into account the type, extent, and severity of the disease 5.
• A step-by-step approach to treatment, starting with standard modalities and progressing to alternative systemic treatments, may be helpful in optimizing treatment outcomes 5.
• Early initiation of systemic therapy may be beneficial for patients with severe or widespread disease to prevent significant morbidity and impact on daily function 4.