From the Guidelines
Lichen Planus (LP) should be diagnosed based on clinical presentation and treated with high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05%, as first-line therapy. The diagnostic criteria for LP include characteristic purple, polygonal, pruritic, flat-topped papules on the skin, white lacy patterns (Wickham's striae) on oral mucosa, or nail changes like ridging and splitting 1. Diagnosis is primarily clinical but can be confirmed with a skin biopsy showing band-like lymphocytic infiltrate and damage to the basement membrane.
Treatment Options
For treatment, the following options are recommended:
- High-potency topical steroids (eg, clobetasol 0.05% or fluocinonide 0.05% [cream or ointment]) or tacrolimus (0.1% ointment) for all grades of lichen planus and lichenoid diseases 1
- Oral antihistamines, prednisone, and narrow-band UVB phototherapy (if available) for severe or widespread disease 1
- Gel can be considered for mucosal disease, solution for scalp disease, and cream/lotion/ointment for all other affected areas 1
Disease Management
Lichen planus is an autoimmune condition where T-cells attack skin and mucous membranes, and while it often resolves spontaneously within 1-2 years, oral lesions may persist longer and require maintenance therapy. Regular follow-up is important, especially for oral lesions, due to a small risk of malignant transformation.
Key Considerations
- Potent topical corticosteroids, such as clobetasol 0.05% ointment, are effective for cutaneous lichen planus 1
- Topical corticosteroids, such as fluocinonide 0.05% gel, or steroid mouth rinses, such as dexamethasone 0.5mg/5mL, are effective for oral lichen planus 1
- Oral prednisone, oral retinoids like acitretin, or phototherapy may be considered for severe or widespread disease 1
From the Research
Diagnostic Criteria for Lichen Planus (LP)
- Lichen planus lesions are described using the six P's (planar [flat-topped], purple, polygonal, pruritic, papules, plaques) 2
- Onset is usually acute, affecting the flexor surfaces of the wrists, forearms, and legs 2
- The lesions are often covered by lacy, reticular, white lines known as Wickham striae 2
- A 4-mm punch biopsy is often helpful and is required for more atypical cases 2
Treatment Options for Lichen Planus (LP)
- High-potency topical corticosteroids are first-line therapy for all forms of lichen planus, including cutaneous, genital, and mucosal erosive lesions 2, 3, 4
- Topical tacrolimus appears to be an effective treatment for vulvovaginal lichen planus 2
- Systemic corticosteroids should be considered for severe, widespread lichen planus involving oral, cutaneous, or genital sites 2, 5, 4
- Systemic retinoids, such as acitretin, and oral immunosuppressants may be considered for patients with severe lichen planus that does not respond to topical treatment 6, 2
- Phototherapy modalities, such as cyclosporine and retinoids, may also be used to treat lichen planus 6, 5
Treatment Considerations
- The most suitable corticosteroid therapy in the management of OLP is the topical therapy, which is easier and more cost-effective than the systemic therapy followed by topical therapy 4
- A larger concentration of the active molecules cannot further improve the therapeutic findings or optimize the obtained results in a significant manner 3
- Treatment has to be long, and the onset of adverse side effects from long-term therapy must be taken into account 5