What is the recommended treatment for oral lichen planus?

Treatment of Oral Lichen Planus

High-potency topical corticosteroids are the first-line treatment for oral lichen planus, with clobetasol 0.05% or fluocinonide 0.05% gel being the most effective options for mucosal disease. 1, 2

First-Line Treatment Options

• Topical corticosteroids in gel form are the mainstay treatment for all grades of oral lichen planus (OLP), providing effective symptom relief with minimal side effects 1, 3
• Clobetasol propionate 0.05% gel and fluocinonide 0.05% gel are the preferred agents, applied to dried mucosa twice daily 2
• Gel formulations are specifically recommended over creams or ointments for oral mucosal disease 1, 2
• For localized lesions, clobetasol 0.05% can be mixed in 50% Orabase to improve adhesion 2

Treatment Algorithm Based on Disease Severity

Mild to Moderate Disease

• Apply high-potency topical corticosteroids (clobetasol 0.05% or fluocinonide 0.05% gel) to dried mucosa twice daily for 2-3 months 1, 2
• After symptom improvement, gradually taper the frequency to avoid rebound flares 1
• Complete remission of signs can be achieved in approximately 69% of patients with topical therapy alone 4

Moderate to Severe Disease

• Continue topical corticosteroids as the primary treatment 1, 2
• Consider adding oral antihistamines for additional symptom control, particularly for pruritus 2
• For widespread or severe erosive disease, a short course of oral prednisone may be considered, followed by maintenance with topical corticosteroids 5
• Narrow-band UVB phototherapy is an alternative option for moderate to severe disease 2

Refractory Cases

• Topical calcineurin inhibitors (tacrolimus 0.1% ointment) are effective alternatives when corticosteroids are contraindicated or ineffective 1, 2
• Consider intralesional triamcinolone acetonide injections for persistent lesions 2
• Doxycycline with nicotinamide may be beneficial for cases not responding to standard therapy 2
• Referral to dermatology for systemic immunomodulators should be considered for highly refractory cases 1, 2

Important Clinical Considerations

• Biopsy is necessary to confirm diagnosis in atypical cases and to rule out malignancy before initiating treatment 2, 6
• Regular follow-up at 3-month intervals is essential to assess treatment response and monitor for adverse effects 1, 2
• The most common side effect of topical corticosteroid therapy is oral candidiasis, which may require concurrent antifungal treatment 3
• Systemic corticosteroids should be reserved for acute exacerbations or widespread lesions, as they offer no advantage over topical therapy for long-term management and carry greater risk of side effects 4, 5
• One-third of patients treated with systemic corticosteroids experience systemic side effects, compared to none with topical therapy alone 4
• OLP is a chronic disorder requiring long-term management; topical steroids are recommended for maintenance therapy due to minimal side effects and cost-effectiveness 3
• Patients should be advised to avoid oral irritants and fragranced products that may exacerbate the condition 2
• Regular monitoring is important as certain forms of OLP have potential for malignant transformation, though the exact incidence remains controversial 6