From the Guidelines
The best 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. This recommendation is based on the most recent and highest quality study available, which suggests that these treatments are effective for all grades of lichen planus and lichenoid diseases 1.
Treatment Options
The treatment of lichen planus depends on the severity and location of symptoms. For mild to moderate cases, topical corticosteroids are the first-line therapy.
- High-potency topical corticosteroids, such as clobetasol propionate 0.05% ointment, can be applied twice daily for 2-4 weeks, followed by gradual tapering.
- For oral lichen planus, triamcinolone acetonide 0.1% dental paste can be applied 3-4 times daily after meals and before bedtime.
- In more severe or widespread cases, systemic treatments may be necessary, including oral prednisone, oral retinoids like acitretin, or immunosuppressants such as cyclosporine.
Symptomatic Relief
Symptomatic relief can be achieved with antihistamines for itching and pain management medications as needed. Avoiding potential triggers like certain medications, spicy foods, and dental materials containing metals may help prevent flares. Treatment typically continues until symptoms resolve, which may take several weeks to months, and some cases require maintenance therapy to prevent recurrence.
Evidence
The NCCN guidelines recommend high-potency topical steroids or tacrolimus for all grades of lichen planus and lichenoid diseases 1. Another study found that topical steroids were the most frequently used treatment for lichenoid dermatitis, and were effective in managing the condition 1. While other treatments, such as acitretin, have been shown to be effective in some cases, the most recent and highest quality study available supports the use of high-potency topical steroids or tacrolimus as the first-line treatment 1.
From the Research
Treatment Options for Lichen Planus
- Topical corticosteroids are a common treatment for lichen planus, especially for localized skin lesions 2, 3, 4
- Systemic corticosteroids may be considered for severe, widespread cases or when other mucocutaneous sites are involved 2, 5, 3, 4
- Phototherapy, including narrowband UVB, has been shown to be effective in treating generalized lichen planus 5
- Topical calcineurin inhibitors, vitamin D analogs, and retinoids may also be used to treat lichen planus 2, 4
- A combination of topical corticosteroids and trichloroacetic acid has been reported to be successful in treating verrucous lichen planus 6
Considerations for Treatment
- The choice of treatment should be individualized based on the type, extent, and severity of the disease 2
- Topical therapy is often preferred over systemic therapy due to its ease of use and lower risk of side effects 3, 4
- Patient satisfaction and quality of life should be taken into account when selecting a treatment option 5
- Regular follow-up is recommended to monitor the disease and adjust treatment as needed 4