From the Guidelines
The current treatment guideline for Lichen Planus recommends high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05%, or tacrolimus 0.1% ointment, for all grades of the disease. According to the NCCN guidelines 1, these treatments are effective for managing symptoms and can be used in various forms, including cream, ointment, gel, or solution, depending on the affected area.
Key Treatment Options
- High-potency topical steroids (e.g., clobetasol 0.05% or fluocinonide 0.05%) for cutaneous disease
- Tacrolimus 0.1% ointment as an alternative to topical steroids
- Gel formulation for mucosal disease
- Solution for scalp disease
- Cream, lotion, or ointment for other affected areas
Additional Therapies
- Oral antihistamines for itching
- Prednisone for severe cases
- Narrow-band UVB phototherapy for widespread cutaneous disease, if available 1 These recommendations prioritize symptom management and aim to reduce inflammation and alleviate symptoms, ultimately improving the patient's quality of life 1.
From the Research
Current Treatment Guidelines for Lichen Planus
The current treatment guidelines for Lichen Planus involve various therapeutic options, including:
- Topical therapies, such as clobetasol propionate, topical tacrolimus, and bath-PUVA, as mentioned in 2
- Intralesional treatment with triamcinolone, as discussed in 2
- Systemic treatment, including corticosteroids, retinoids, small molecule inhibitors (JAK/STAT inhibitors), TNF-alpha inhibitors (etanercept), systemic immunomodulators (oral calcineurin inhibitors, mycophenolate mofetil), and antimalarials (chloroquine), as outlined in 2
- High-dose clobetasol propionate 0.05% for cutaneous lichen planus, which has been shown to be effective and well-tolerated, as reported in 3
Treatment Options for Specific Forms of Lichen Planus
For oral lichen planus, the following treatment options are recommended:
- Clobetasol propionate at 0.025-0.05% for topical application as the first therapeutic alternative, as suggested in 4
- 0.1% tacrolimus and 1% pimecrolimus for topical regimen, as mentioned in 4
- Systemic corticosteroids and the application of diode lasers, as discussed in 4
Comparison of Treatment Options
A comparative study of clobetasol and ciclosporin in the topical management of atrophic and erosive oral lichen planus found that:
- Clobetasol was more effective than ciclosporin in inducing clinical improvement, as reported in 5
- Clobetasol had comparable effects on symptoms, but gave less stable results than ciclosporin when therapy ended, as mentioned in 5
- Clobetasol had a higher incidence of side-effects compared to ciclosporin, as discussed in 5
General Treatment Principles
Mild cases of lichen planus can be treated with rest, topical corticosteroids, or occlusion, as mentioned in 6 Severe generalized cases may require systemic corticosteroids, as discussed in 6 Chronic, aggressive lesions may need additional therapy, ranging from psoralen plus ultraviolet A (PUVA) to retinoids or cyclosporin, as outlined in 6