management

Last edited 09/2020 and last reviewed 03/2021

Possible preparations in the management of cutaneous lichen planus include:

• systemic antihistamines
• weak coal tar preparations,
• 1- menthol in calamine lotion
• topical steroids
  • skin lesions respond, albeit slowly, to topical steroid treatment, but it is necessary to use potent or very potent agents in order to achive much improvement
  • patients need to be warned that staining may occur and that continued application of treatment will not improve this and may lead to skin atrophy (1)

In severe cases intradermal (or even systemic) steroids may be indicated. Vitamin A (retinoic acid) or one of the synthetic retinoids may be helpful in this condition.

Phototherapy in the form of narrow-band UVB as TLO-1 may be helpful for resistant cases and for extreme pruritis.

Immunosuppressives e.g. cyclosporine and azathioprine have been used in recalcitrant cases.

Oral lesions are more difficult to manage:

Troublesome oral symptoms can be treated as follows (3):

• Topical analgesia is available as a mouthwash and spray eg Difflam ® 
• A number of topical anti-inflammatories can be used as a gargle for 2-4 minutes, 3-4 times a day
  • Betamethasone 500 microgram soluble tablet dissolved in 10 ml of water 
  • Flixonase ® Nasule ® drop 400 micrograms dissolved in 10 ml of water 
  • Doxycycline 100 mg dispersible tablets have both anti-inflammatory and antibacterial properties
• there are various methods of delivering topical steroids to the oral mucosa (e.g. lozenges, pastes) but responses are often indifferent and secondary candida infection is all too common (1,2)
• there is data that suggest that tacrolimus or pimecrolimus may have a role in the management of oral lichen planus (1)
• in patients with chronic oral lichen planus then these patients should be kept under surveillance for the development of oral cancer (1)
  

Hyperpigmentation 

• There is no good treatment that can help reduce the hyperpigmentation found in some forms of lichen planus, and in post-inflammatory lesions

Reference:

1. Dermatology in Practice 2004; 12 (2): 25-6.
2. Usatine R, Tinitigan M. Diagnosis and Treatment of Lichen Planus. American Family Physician. 2011 Jul1;84 (1):53-60.
3. Primary Care Dermatological Society. Lichen planus (Accessed 2/9/2020)