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Lichen planus

Guidelines

Key sources

The following summarized guidelines for the management of lichen planus are prepared by our editorial team based on guidelines from the European Academy of Dermatology and Venereology (EADV/EDF 2020), the Royal College of Ophthalmologists (RCOphth 2020), and the European Academy of Dermatology and Venereology (EADV 2017). ...
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Medical management

Management of cutaneous lichen planus: as per EADV/EDF 2020 guidelines, offer the following as first-line therapy in patients with cutaneous lichen planus:
topical corticosteroids (superpotent and potent such as triamcinolone acetonide, fluocinolone acetonide, betamethasone dipropionate and clobetasol propionate)
intralesional triamcinolone, especially for more hypertrophic or unresponsive lesions (5-20 mg/mL every 2-4 weeks)
systemic corticosteroids (oral or IM injections) If lesions are unresponsive to topical treatment (oral prednisone of 30-80 mg/day for 4-6 weeks or IM injections of triamcinolone 40-80 mg every 6-8 weeks)
acitretin (20-35 mg/day) or isotretinoin
oral cyclosporine (3-5 mg/kg/day).
E
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  • Management of oral lichen planus

  • Management of genital lichen planus

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Follow-up and surveillance

Follow-up
As per EADV 2017 guidelines:
Obtain careful monitoring for all potentially toxic therapies (such as azathioprine, dapsone, griseofulvin, chloroquine, minocycline, cyclosporine, methotrexate, mycophenolate, retinoids, oral corticosteroids) preferably supervised by a dermatologist at a specialized clinic.
B
Assess active disease as clinically required. Ensure long-term specialized follow-up in patients with erosive vulvar lichen planus.
B

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