Treatment
Rule out drug-induced lichen planus before initiating treatment!
- Discontinue suspected drug
- Topical corticosteroids ± occlusion
- Intralesional corticosteroids (hypertrophic)
- Oral antihistamines
1st line:
- Prednisone ≥ 20 mg daily x 2-6 weeks then taper over weeks
- Narrowband ultraviolet B
Recalcitrant:
- Acitretin 30 mg daily
- Alitretinoin 25 mg daily
- Metronidazole
- Sulfasalazine
- Immunosuppressants e.g. Methotrexate, Mycophenolate mofetil, Cyclosporine, Azathioprine
- Thalidomide
- Tumor necrosis factor -α inhibitors
- Apremilast
- Intravenous immunoglobulin + prednisone
- Psoralen and ultraviolet A/ Narrowband ultraviolet B
1st line:
- High potency topical corticosteroids
- Topical calcineurin inhibitors
- Topical retinoids
2nd line:
- Immunosuppressants: methotrexate, azathioprine, mycophenolate mofetil
- Low dose prednisone
1st line:
- Topical/intralesional corticosteroids
2nd line:
- Hydroxychloroquine 200 mg twice daily
- 5- α reductase inhibitors (frontal fibrosing alopecia)
- Mycophenolate mofetil, cyclosporine A
1st line:
- Inhaled/topical corticosteroids
- Topical calcineurin inhibitors
- Topical retinoids
Refractory:
- Topical rapamycin
- Alitretinoin
- Methotrexate
- Griseofulvin (erosive)
- Extracorporeal photopheresis
- Excimer laser
- Topical/intralesional corticosteroids
- Systemic corticosteroids (severe cases)
- Acitretin and Alitretinoin
- Immunosuppressants e.g. Methotrexate