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Lichen planus (LP) can be difficult to manage. Inconsistent response to therapy often frustrates patients and physicians. Many patients with LP will experience only mild symptoms, but for others, the disease causes severe discomfort. Therefore, an individualized approach to treatment is required, with careful consideration of disease burden as well as the risks and benefits of treatment options. A multidisciplinary approach involving dermatologists, dentists, otolaryngologists, gynecologists, gastroenterologists, and others may be necessary depending on disease distribution. Clinically relevant drugs known to exacerbate LP should be discontinued if possible. Patients should take precautions to minimize trauma to the skin and mucosal surfaces. Good oral hygiene, including regular professional dental care, should be encouraged.1 Contact reactions to metals can trigger LP, therefore patch testing is often beneficial for oral lichen planus (OLP).
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Various pharmacologic and light-based treatments have been proposed for mucosal lichen planus (MLP), cutaneous lichen planus (CLP), and the related disorders lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA). Evidence supporting most of these therapies is limited to small case series and anecdotes, and is at best inconclusive.2 Topical immunosuppressive agents have the highest level of evidence supporting their use as first-line therapies. Systemic immunosuppressive and anti-inflammatory agents are indicated for generalized, severe, and/or refractory disease.2 Systemic 5α-reductase inhibitors are recommended as first-line adjunctive therapy for hair loss secondary to frontal fibrosing alopecia (FFA).3 They should be used concomitantly with topical/intralesional corticosteroids or systemic immunosuppressants.4 See Table 12-1.
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