From the Guidelines
Lichen planus should be treated with high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05%, or tacrolimus 0.1% ointment, as recommended by the NCCN guidelines 1. The treatment approach for lichen planus depends on the severity and location of the disease.
- For mild cases, high-potency topical steroids are recommended, which can be applied as a cream, ointment, or gel, depending on the affected area 1.
- For moderate to severe cases, oral antihistamines, prednisone, and narrow-band UVB phototherapy may be considered, in addition to topical treatments 1.
- In cases where immunotherapy-related toxicities are suspected, referral to dermatology and consideration of steroid-sparing immunosuppressants, such as azathioprine, cyclosporine, or methotrexate, may be necessary 2. The goal of treatment is to reduce symptoms, prevent complications, and improve quality of life, while minimizing the risk of adverse effects and malignant transformation.
- Regular monitoring and follow-up are essential to adjust treatment plans as needed and to detect any potential complications early on 1, 2.
From the Research
Definition and Characteristics of Lichen Planus
- Lichen planus (LP) is a chronic lichenoid inflammatory disorder of the skin, mucosa, and appendages 3.
- It is characterized by a rich infiltration of inflammatory T cells in the upper part of the dermis, arranged in a band-like pattern 3.
Treatment Options for Lichen Planus
- Standard therapeutic approaches include various topical treatments, such as topical corticosteroids, calcineurin inhibitors, and vitamin D analogs, as well as phototherapy modalities and systemic corticosteroids 4.
- Topical corticosteroids are the mainstay treatment for oral lichen planus (OLP) 5.
- Systemic corticosteroid therapy may be necessary for acute presentations of OLP, but it can have significant side effects 6, 5.
- Other treatment options include cyclosporine, retinoids, and immunosuppressants, but the evidence for their effectiveness is limited 4, 6, 7.
Challenges in Treating Lichen Planus
- LP can be a therapeutic enigma, especially for mucosal or scalp-affecting types, which often present a recalcitrant and treatment-unresponsive course 3.
- The disease has a high psychosocial burden, and efficacious therapeutic options are still lacking for some types of LP 3.
- Larger randomized, controlled trials are needed to establish the exact benefits of different treatments for LP 7.