Lichen Planus

LICHEN PLANUS UPDATED GUIDELINES
European S1 guidelines
Journal of the European Academy of Dermatology and Venereology 2020
By: Mohammed Alghamdi R1 Supervised by: Abdullah Al-Omair R2
Cutaneous lichen planus
Topical steroids (superpotent and potent such as triamcinolone acetonide, fluocinolone acetonide, betamethasone dipropionate and
clobetasol propionate)
First Line Triamcinolone intralesional injection, especially for more hypertrophic or unresponsive lesions (5–20 mg/mL every 2–4 weeks)
Treatment Systemic corticosteroids (oral or intramuscular injections) If lesions are unresponsive to topical treatment, oral prednisone of
30–80 mg/day for 4–6 weeks or intramuscular injections of triamcinolone 40–80 mg every 6–8 weeks are administered.
Acitretin 20–35 mg/day, or isotretinoin
Oral cyclosporine (3–5 mg/kg/day)
Broadband or narrowband UVB.

Combination of UV and acitretin
Second Line Topical calcineurin inhibitors (tacrolimus, pimecrolimus – twice/day for 1–2 months)
Treatment Sulphasalazine, initial dose of 1.5 g/day increased by 0.5 g/week to 3 g/day for 4–16 weeks
Topical calcipotriol ointment

Metronidazole (250 mg)every 8 h for 12 weeks)
Trimethoprim–sulphomethoxazole
Hydroxychloroquine sulphate (200–400 mg/day)
Itraconazole, terbinafine, griseofulvin (why antifungal therapy is sometimes effective in LP remains to be elucidated)
Third Line Tetracycline,Doxycycline ,Mycophenolate mofetil (0.5 g twice daily for four weeks, and then 1 g twice daily for at least 20 weeks
Treatment Azathioprine (50 mg twice daily orally or 1–2 mg/kg/day, for a period varying from 3 to 7 months)
Methotrexate (15–20 mg/week for 4–15 weeks)
Cyclophosphamide(50–100 mg/day for 3–6 months) , Thalidomide , adalimumab
Interferon a2b. Interesting approach especially if lichen planus is associated with hepatitis C.
Alitretinoin
Low molecular weight heparin (enoxaparin 3 mg/week)
Photodynamic therapy
Extracorporeal photochemotherapy
Nd-YAG laser, low-dose 308 nm excimer laser
Apremilast
Ustekinumab
Oral Antihistamines
Symptomatic Topical antipruritic agents Menthol, camphor, doxepin, polidocanol
treatment
Oral Lichen Planus
Topical steroids (clobetasol propionate 0.05%, triamcinolone, betamethasone, fluocinonide, fluticasone,

dexamethasone and prednisolone in different forms). Intralesional injection of corticosteroids (triamcinolone acetonide
hydrocortisone, dexamethasone and methylprednisolone) in ulcerative OLP.
Systemic corticosteroids (oral) Systemic corticosteroids, methylprednisolone or prednisone (30–80 mg/day)
First Line Systemic retinoids, such as acitretin (25–50 mg/day) initially, followed by isotretinoin (0.5–1 mg/kg/day),
Treatment Topical retinoids (isotretinoin 0.05–0.1%) or other forms of vitamin A derivatives can eliminate white lesions
Oral cyclosporine (3–10 mg/kg/day)
Topical calcineurin inhibitors, tacrolimus and pimecrolimus

Sulphasalasine (2.5 g/day for 6 weeks)
Azathioprine (50 mg twice daily orally or 1–2 mg/kg/day, for a period varying from 3 to 7 months)
Second Line Hydroxychloroquine sulphate (200–400 mg/day for 2 months)
Treatment Methotrexate (15 mg/week for 3 months)
Mycophenolate mofetil (1 to 3 g/daily twice daily for 4 weeks)
TNF-a inhibitors (alefacept, adalimumab, etanercept) can be used with uncertain efficacy, because studies
of large series of patients are lacking
Cyclophosphamide (100 mg/day)
Thalidomide106 (initial dose of 50 to 100 mg/day and then progressively decreased to the minimal effective dose),
Antibiotic treatment for 1–3 month (metronidazole – 250 mg every eight hours daily, trimethoprim–
sulphomethoxazole, tetracycline 500 mg twice daily, doxycycline 100 mg twice daily)
Itraconazole , griseofulvin
Dapsone (initial dose of 50 mg/day is given for the first 15 days, and then, the dose is increased to 100 mg/day)
Low molecular weight heparin (enoxaparin 3 mg/week)
Interferon has been used as a treatment modality in cases of LP associated with hepatitis C
Levamisole (50 mg thrice daily or 150 mg once daily, for three consecutive days per week for at least 3 months)
Lycopene (8 mg/day for 8 weeks)
Purslane (235 mg/day)
Third Line Curcuminoids (6000 mg/day 3 divided doses),
Treatment Aloe vera
Topical tocopherol
Colchicine
0.5 mL of intralesional BCG (bacillus Calmette-Guerin) injection was used every other day for two weeks and proved
to be as effective as 10 mg triamcinolone acetonide injections every week for 2 weeks.
Extracorporeal photochemotherapy
Psoralen plus UVA (PUVA), UVA1, broadband or narrowband UVB
Er: YAG laser (2940 nm) diode laser (630 nm),carbon dioxide laser
Genital Lichen Planus
Topical steroids (hydrocortisone acetate 25 mg rectal suppositories can be inserted in the vagina nightly, or 1 g
clobetasol or another potent topical corticosteroid ointment) Calcineurin inhibitor, tacrolimus – pimecrolimus Local
anaesthetic gel, sedating antihistamines, low-dose tricyclic antidepressants or anticonvulsants
Lichen Planopilaris
Topical steroids (superpotent, potent, mild)

Intralesional injection of corticosteroids (e.g. triamcinolone 5-20 mg/mL every 2–4 weeks)
Systemic steroids (30–80 mg/day of prednisone)
First Line Cyclosporine in systemic administration (3–10 mg/kg/day)
Treatment Hydroxychloroquine sulphate (200–400 mg/day or 6.5 mg/kg per day for 6 to 12 months)
Methotrexate (15 mg/weekly for 6 months)
Topical calcineurin inhibitors, primarily tacrolimus
Systemic retinoids such as acitretin (25–30 mg/day) and isotretinoin (0.5–1 mg/kg/day) for 3–
6 months, especially in cases with pronounced perifollicular hyperkeratosis.
Tetracycline/doxycycline (100 mg/d for one month)
Mycophenolate mofetil (0.5 g twice daily for four weeks, and then 1 g twice daily for at least
20 weeks)
Second Line Adalimumab, at the same dose and schedule as in psoriasis
Treatment Pioglitazone, an oral PPAR-γ agonist (15 mg orally once a day for 8 months)
Minoxidil solution 5%
Thalidomide (initial dose 100–300 mg per day)
Rituximab (IV 375 mg/m2 once weekly for 4 or 8 doses)
308 nm excimer laser
Frontal Fibrosing Alopecia
Treatment modalities for FFA include all medications described for the treatment of LPP. However, several authors
believe that oral cyclosporine (3–6 mg/kg/day) and oral finasteride (2, 5 mg daily) or dutasteride (0.5 mg daily) for
12 months could be of considerable value. However, since the coexistence of FFA and androgenetic alopecia is very
common, the effect of finasteride/dutasteride in FFA is doubtful.
Topical minoxidil or intralesional corticosteroids have been prescribed more often as an adjuvant to the previous
treatments, depending on the stage of the disease and association with androgenetic alopecia.
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LICHEN PLANUS UPDATED GUIDELINES

By: Mohammed Alghamdi R1 Supervised by: Abdullah Al-Omair R2

Cutaneous lichen planus

Broadband or narrowband UVB.

Topical calcipotriol ointment

Topical steroids (clobetasol propionate 0.05%, triamcinolone, betamethasone, fluocinonide, fluticasone,

Topical calcineurin inhibitors, tacrolimus and pimecrolimus

Genital Lichen Planus

Topical steroids (superpotent, potent, mild)

Nail Lichen Planus

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