What is the recommended treatment for hypertrophic lichen planus in an 8-year-old boy?

Treatment of Hypertrophic Lichen Planus in an 8-Year-Old Boy

The recommended first-line treatment for hypertrophic lichen planus in an 8-year-old boy is a potent topical corticosteroid applied once daily for 2-3 months, with gradual tapering after clinical improvement. 1, 2

First-Line Treatment Approach

• Medium to high-potency topical corticosteroids are the mainstay of treatment for pediatric lichen planus, with complete or partial response seen in 64% of cutaneous cases 1
• For hypertrophic variants specifically, which are characterized by thickened, scaly plaques that are often pruritic and chronic in nature, potent topical steroids should be applied once daily to affected areas 2, 3
• Treatment should be continued until symptoms improve and hyperkeratosis resolves, typically over 2-3 months, followed by a gradual taper to avoid rebound flares 4, 1
• Advise avoidance of all irritants and fragranced products that may exacerbate the condition 5

Treatment Regimen Details

• Begin with a potent topical corticosteroid such as clobetasol propionate 0.05% or mometasone furoate applied once daily for 4 weeks 5
• After initial improvement, reduce frequency to alternate days for 4 weeks, then twice weekly for another 4 weeks 5
• Explain to parents/caregivers the proper amount to use (fingertip unit method) and safe application technique to minimize side effects 5
• A 30g tube should last approximately 12 weeks when used appropriately 5

Monitoring and Follow-up

• Schedule follow-up at 3 months to assess treatment response and ensure proper medication use 5
• If good response is achieved, schedule another assessment 6 months later to ensure continued improvement before considering discharge 5
• Monitor for potential side effects of prolonged topical steroid use, though studies have shown that this regimen is generally safe in children when used appropriately 5, 1

For Refractory Cases

• If inadequate response after 3 months of appropriate topical steroid therapy, consider referral to a specialist dermatology clinic 5
• For resistant hypertrophic lesions, intralesional triamcinolone (10-20 mg) may be considered after excluding malignancy by biopsy 5
• In severe or widespread cases unresponsive to topical therapy, systemic options such as acitretin may be considered, which has shown excellent response in hypertrophic lichen planus cases 6
• Other second-line options for refractory cases include narrow-band UVB phototherapy or oral antihistamines for pruritus control 4, 2

Important Clinical Considerations

• Hypertrophic lichen planus represents approximately 8.2% of pediatric lichen planus cases and tends to be more chronic and resistant to treatment than classic variants 2
• Complete examination of oral mucosa, nails, and genitalia is essential as involvement of these sites may occur in pediatric patients (18% oral, 13.9% nail, and 4.4% genital involvement reported) 2
• Long-term remission is achievable in approximately 81% of pediatric lichen planus cases with appropriate treatment 1
• Biopsy may be necessary in atypical or treatment-resistant cases to confirm diagnosis and exclude other conditions 5, 3