What is the treatment used for lichen planus?

From the Guidelines

High-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05%, or tacrolimus 0.1% ointment, are recommended for the treatment of lichen planus. According to the NCCN guidelines, version 2.2024 1, these treatments are suitable for all grades of lichen planus and lichenoid diseases. The choice of formulation depends on the affected area, with gel considered for mucosal disease, solution for scalp disease, and cream/lotion/ointment for all other affected areas.

Treatment Options

• High-potency topical steroids (e.g., clobetasol 0.05% or fluocinonide 0.05%)
• Tacrolimus 0.1% ointment
• Oral antihistamines
• Prednisone
• Narrow-band UVB phototherapy (if available) These treatments aim to reduce inflammation and suppress the abnormal immune response that causes lichen planus, as noted in the NCCN guidelines 1.

Key Considerations

• The treatment should be chosen based on the severity and location of the disease
• The NCCN guidelines, version 2.2024 1, provide the most recent and highest-quality evidence for the treatment of lichen planus
• The recommended treatments are effective in reducing symptoms and improving quality of life for patients with lichen planus, as supported by the NCCN guidelines 1

From the Research

Treatment Options for Lichen Planus

• Topical corticosteroids are a common treatment for lichen planus, particularly for oral lichen planus [(2,3,4,5,6)]
• Systemic corticosteroids may be used for severe or widespread cases, but are generally reserved for acute exacerbations or multiple lesions [(2,3,5,6)]
• Other treatment options include:
  • Calcineurin inhibitors 2
  • Vitamin D analogs 2
  • Phototherapy [(2,5)]
  • Systemic retinoids 2
  • Methotrexate 2
  • Hydroxychloroquine 2
  • Cyclosporine [(2,5)]
  • Azathioprine 2
  • Mycophenolate mofetil 2

Efficacy of Topical Corticosteroids

• Topical corticosteroids have been shown to be effective in reducing symptoms and improving clinical outcomes in patients with oral lichen planus [(3,4,6)]
• A randomized controlled trial found that topical clobetasol propionate 0.025% and 0.05% were both effective in improving symptoms and clinical outcomes, with no significant difference between the two concentrations 4
• Another study found that topical corticosteroids were effective in achieving complete remission of signs and symptoms in 68.2% of patients with oral lichen planus 3

Side Effects and Considerations

• Systemic corticosteroids can have significant side effects, including systemic side effects such as candidiasis, bad taste, nausea, dry mouth, sore throat, and swollen mouth [(3,6)]
• Topical corticosteroids are generally well-tolerated, but can cause minor side effects such as candidiasis, bad taste, and dry mouth 6
• The use of steroids in the treatment of lichen planus should be carefully considered, taking into account the potential benefits and risks 6