How to treat hyperpigmentation after lichen planus treatment?

From the Guidelines

To treat hyperpigmentation after lichen planus treatment, prioritize sun protection and moisturizing, as these measures can help prevent further skin darkening and promote healing. When considering treatment options, it's essential to weigh the potential benefits and risks, focusing on minimizing morbidity, mortality, and improving quality of life. Given the available evidence, the most recent and highest quality study 1 provides guidance on managing immunotherapy-related toxicities, including lichen planus and lichenoid diseases, but does not directly address hyperpigmentation treatment. However, the study suggests the use of high-potency topical steroids or tacrolimus for lichen planus and lichenoid diseases, which may indirectly help with hyperpigmentation by reducing inflammation. Additionally, another study 1 emphasizes the importance of prevention measures such as moisturizing regularly, protecting against excessive sunlight exposure, using SPF 30 UVA and UVB protective sunscreen, and using emollients or soap substitutes. While these studies do not provide a direct answer to treating hyperpigmentation after lichen planus, they highlight the importance of sun protection and skin care. Some key points to consider in treating hyperpigmentation include:

• Using topical treatments such as hydroquinone, azelaic acid, retinoids, or vitamin C serums
• Applying broad-spectrum SPF 30+ sunscreen every 2 hours when outdoors and wearing protective clothing
• Considering chemical peels or microdermabrasion for persistent cases
• Being patient, as post-inflammatory hyperpigmentation from lichen planus typically fades gradually over months. It's crucial to consult a dermatologist for personalized advice and to discuss alternative options like laser therapy if no improvement occurs after consistent treatment. The evidence from 1 and 1 supports the use of topical steroids and other treatments for lichen planus and lichenoid diseases, but the treatment of hyperpigmentation specifically requires a more nuanced approach, prioritizing sun protection and moisturizing.

From the FDA Drug Label

To prevent repigmentation, during treatment and maintenance therapy, sun exposure on treated skin should be avoided by application of a broad spectrum sunscreen (SPF 15 or greater) or by use of protective clothing.

• Hyperpigmentation treatment: The use of hydroquinone, a skin bleaching agent, may help treat hyperpigmentation after lichen planus treatment.
• Prevention of repigmentation: To prevent repigmentation, it is essential to avoid sun exposure on treated skin by using a broad spectrum sunscreen (SPF 15 or greater) or protective clothing.
• Key considerations: Close patient supervision is recommended, and patients should be cautioned on concomitant use of medications that are known to be photosensitizing 2.

From the Research

Treatment Options for Hyperpigmentation after Lichen Planus

• Combination therapy with chemical peels and topical retinoids has been shown to be effective in treating hyperpigmentation after lichen planus treatment, as seen in a case study where an 18-year-old Hispanic man responded dramatically to a combined regimen of daily topical azelaic acid foam and tretinoin cream with twice-monthly chemical peels using glycolic acid and Jessner's solution 3.
• Low-dose oral isotretinoin therapy has also been found to be effective in managing lichen planus pigmentosus, with 85.2% of patients showing moderate to good improvement in hyperpigmentation 4.
• Pigment laser treatment has been used to treat lichen planus pigmentosus that is recalcitrant to topical treatment, with a case study showing significant improvement in a 50-year-old Chinese woman 5.
• Oral tranexamic acid has been used off-label in dermatology to treat hyperpigmentation disorders, including lichen planus pigmentosus, with variable efficacy and a good safety profile 6.

Important Considerations

• Hyperpigmentation is a potential side effect of re-PUVA therapy, and cases of intense transient hyperpigmentation have been reported 7.
• The effectiveness of these treatment options may vary depending on the individual case and the severity of the hyperpigmentation.
• More research is needed to determine the efficacy of these treatment options in treating hyperpigmentation after lichen planus treatment.

Treatment Approaches

• Topical treatments, such as azelaic acid foam and tretinoin cream, may be used in combination with chemical peels to treat hyperpigmentation.
• Oral medications, such as isotretinoin and tranexamic acid, may be used to manage lichen planus pigmentosus and hyperpigmentation.
• Laser treatment, such as pigment laser, may be used to treat hyperpigmentation that is recalcitrant to topical treatment.