From the Guidelines
The most effective treatment for lichen planus is high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05%, or tacrolimus 0.1% ointment, as recommended by the NCCN guidelines 1. These medications are recommended for all grades of lichen planus and lichenoid diseases due to their ability to reduce inflammation and suppress the immune response. The choice of formulation, such as gel, solution, or cream/lotion/ointment, depends on the affected area, with gel considered for mucosal disease, solution for scalp disease, and cream/lotion/ointment for all other affected areas 1. In addition to topical treatments, oral antihistamines, prednisone, and narrow-band UVB phototherapy may also be recommended for the management of lichen planus 1. Key points to consider when treating lichen planus include:
- The use of high-potency topical steroids as first-line therapy
- The selection of the appropriate formulation based on the affected area
- The potential need for additional treatments, such as oral antihistamines or phototherapy, in some cases
- The importance of following the NCCN guidelines for the management of lichen planus, as outlined in the 2024 guidelines 1.
From the Research
Treatment Options for Lichen Planus
- Topical treatments, including topical corticosteroids, calcineurin inhibitors, and vitamin D analogs, are standard therapeutic approaches for lichen planus 2
- Phototherapy modalities, such as narrowband UVB, have been shown to be effective in treating generalized lichen planus 3
- Systemic corticosteroids, such as prednisolone, can be used to treat severe, widespread lichen planus involving oral, cutaneous, or genital sites 4, 3
- Systemic retinoids, such as acitretin, can be considered for patients with severe lichen planus that does not respond to topical treatment 4
- Other systemic treatments, including methotrexate, azathioprine, cyclosporine, and mycophenolate mofetil, may be effective in treating resistant lichen planus 2, 5
- Biologics may be a promising treatment option, but more research is needed to determine their long-term safety profiles 5
Specific Treatment Regimens
- High-potency topical corticosteroids, such as clobetasol, are first-line therapy for all forms of lichen planus, including cutaneous, genital, and mucosal erosive lesions 6, 4
- Topical tacrolimus may be an effective treatment for vulvovaginal lichen planus 4
- Mini pulse therapy with corticosteroids or low-dose methotrexate may be considered for systemic treatment of lichen planus 5