dermatologic disorders
Lichen Planus
Treatment of Lichen Planus
Local treatments Systemic treatments Sometimes light therapy Asymptomatic lichen planus does not require treatment. Medications suspected of triggering lichen planus should be stopped; it can takes weeks to months after the offending medication has been stopped for the lesions to resolve. Few controlled studies have evaluated treatments. Options differ by location and extent of disease. Most cases of lichen planus on the trunk or extremities can be treated with topical treatments. Topical corticosteroids are first-line treatment for most cases of localized disease. High-potency ointments or creams (eg,clobetasol,fluocinonide) may be used on the thicker lesions on the extremities; lower-potency corticosteroids (eg,hydrocortisone,desonide) may be used on the face, groin, and axillae. As always, courses should be limited to reduce risk of corticosteroid atrophy. Potency may be enhanced with use of polyethylene wrapping orflurandrenolidetape. Intralesional corticosteroids (triamcinoloneacetonide solution diluted with saline to 5 to 10 mg/mL) can be used every 4 weeks for hyperkeratotic plaques, scalp lesions, and lesions resistant to other therapies. Local therapy is impractical for generalized lichen planus; thus, an oral medication or phototherapy is used. Oral corticosteroids (eg,prednisone20 mg once a day for 2 to 6 weeks followed by a taper) may be used for severe cases. The disease may rebound when therapy ceases; however, long-term systemic corticosteroids should not be used. Oral retinoids (eg,acitretin) are indicated for otherwise recalcitrant cases. Light therapy using psoralen plus ultraviolet A (PUVA) or narrowband ultraviolet B (NBUVB) is an alternative to oral therapies, especially if they have failed or are contraindicated. (a phosphodiesterase-4 inhibitor used to treat psoriasis) ( Treatment references ). There are also reports of favorable outcomes with off-label use of IL-17, IL-23, and tumor necrosis factor (TNF) inhibitors in the management of lichen planus ( Treatment references ). Treatment of oral lichen planus differs slightly from the treatment of other affected areas. Viscouslidocainemay help relieve symptoms of erosive ulcers; because inflamed mucous membranes can absorb high amounts, dose should not exceed 200 mg (eg, 10 mL of a 2% solution) or 4 mg/kg (in children) 4 times a day.Tacrolimus0.1% ointment applied twice daily may induce lasting remission, but the data are limited. Other treatment options include topical (in an adhesive base), intralesional, and systemic corticosteroids. Erosive oral lichen planus may respond to oraldapsone,hydroxychloroquine, orcyclosporine.Cyclosporinerinses also may be helpful. 1.Viswanath V, Joshi P, Dhakne M, et al: Evaluation of the efficacy and safety ofapremilastin the management of lichen planus.Clin Cosmet Investig Dermatol15:2593-2600, 2022. doi: 10.2147/CCID.S390591 2.Mital R, Gray A, Minta A, et al: Novel and off-label biologic use in the management of hidradenitis suppurativa, pyoderma gangrenosum, lichen planus, and seborrheic dermatitis: A narrative review.Dermatol Ther (Heidelb)13(1):77–94, 2023. doi: 10.1007/s13555-022-00860-5 