What is the treatment for lichen planus orale?

Treatment of Oral Lichen Planus

Start with clobetasol 0.05% gel or fluocinonide 0.05% gel applied twice daily to dried oral mucosa as first-line therapy for all grades of oral lichen planus. 1, 2

First-Line Treatment Protocol

• Apply clobetasol 0.05% gel or fluocinonide 0.05% gel as the preferred agents—these are the most effective options for oral mucosal disease 1, 2
• Use only gel formulations for oral lichen planus; never use creams or ointments intraorally as they lack appropriate adherence and efficacy 1, 2
• Apply medication to dried mucosa twice daily to maximize adherence and treatment response 1
• Continue treatment for 2-3 months until symptoms improve to Grade 1 severity 1, 2
• After achieving Grade 1 improvement, taper gradually over 3 weeks to prevent rebound flares 1, 2

Alternative First-Line Option

• Use tacrolimus 0.1% ointment when corticosteroids are contraindicated or ineffective 1, 2
• This topical calcineurin inhibitor serves as an effective alternative to corticosteroids for oral mucosal lesions 2, 3

Treatment Algorithm Based on Disease Severity

Mild to Moderate Disease

• Start high-potency topical corticosteroids in gel form for 2-3 months as outlined above 1, 2
• Monitor response and adjust based on symptom improvement 2

Moderate to Severe Disease

• Continue topical corticosteroids and add oral antihistamines for symptom control 1, 2
• Consider a short course of oral prednisone 15-30 mg for 3-5 days for acute exacerbations 1, 4
• Add narrow-band UVB phototherapy for widespread involvement 1, 2

Refractory Cases

• Consider doxycycline with nicotinamide for treatment-resistant disease 2
• Refer to dermatology for systemic immunomodulators such as methotrexate, acitretin, or hydroxychloroquine 2, 5
• Note that systemic corticosteroids are less cost-effective and carry higher side-effect risk compared to topical therapy, with no superior efficacy for most cases 6

Adjunctive Symptomatic Management

• Apply compound benzocaine gel topically for severe pain control 1
• Use 0.1% chlorhexidine gargling solution to reduce inflammation and prevent secondary infection 1
• Advise patients to avoid irritants and fragranced products that may exacerbate the condition 1

Critical Pitfalls to Avoid

• Never use cream or ointment formulations for oral mucosal disease—only gel formulations provide appropriate adherence for intraoral lesions 1, 2
• Always implement a 3-week taper after achieving Grade 1 improvement; abrupt discontinuation leads to rebound flares 1, 2
• Monitor for candidiasis during topical corticosteroid therapy, as this is the most common side effect 7
• Ensure biopsy confirmation before initiating treatment, as most treatment failures result from improper diagnosis 4

Long-Term Management Considerations

• Oral lichen planus is a chronic disorder requiring long-term treatment, making topical steroids the preferred approach due to minimal side effects and cost-effectiveness 7
• Topical therapy is easier, more cost-effective, and has fewer systemic side effects compared to systemic corticosteroids followed by topical therapy 6
• Regular follow-up is necessary to assess treatment response and monitor for adverse effects 2
• Oral mucosal lichen planus tends to be more persistent and resistant to treatment compared to cutaneous forms 3