Lichen planus (LP) is a poorly characterized, chronic inflammatory dermatosis notable for violaceous to brown/ black polygonal pruritic papules and plaques, often with lacey scale, and reticular white erosions involving mucosal sites. LP affects approximately 1-2% of the population,1 with oral lichen planus (OLP) occurring more frequently and a greater treatment challenge than the genital or cutaneous variants.2 A population based study found patients with OLP were 4.8 times more likely to develop oral squamous cell carcinoma (OSCC) than matched controls.3 Ten to 15% of patients with LP concurrently have nail lichen planus (NLP).4 LP and OLP have been associated with sleep disturbances, anxiety, depression as well as a 37% increased risk for cardiovascular disease (CVD).5,6 Remarkably, no current therapy is FDA approved for LP. This review provides an updated algorithm for treating LP, OLP, and NLP utilizing recent reports and summarizes the latest evidence for off-label therapeutic options (Figure1). Topical corticosteroids (TCS) are the mainstay of treatment for all variants of LP.7
Topical calcineurin inhibitors (TCI), tacrolimus and pimecrolimus, are useful steroid sparing agents, and during scheduled breaks from TCS.8,9 Magic mouthwash has shown a favorable effect for erosive lesions.10 Magic mouthwash is usually a mixture of diphenhydramine, lidocaine, magnesium hydroxide/aluminum hydroxide, nystatin and corticosteroids.11 For recalcitrant OLP, patients can swish-and-spit crushed and dissolved tacrolimus (1mg/500mL) or cyclosporine pills (500mg per 5mL).12,13
Topical calcineurin inhibitors (TCI), tacrolimus and pimecrolimus, are useful steroid sparing agents, and during scheduled breaks from TCS.8,9 Magic mouthwash has shown a favorable effect for erosive lesions.10 Magic mouthwash is usually a mixture of diphenhydramine, lidocaine, magnesium hydroxide/aluminum hydroxide, nystatin and corticosteroids.11 For recalcitrant OLP, patients can swish-and-spit crushed and dissolved tacrolimus (1mg/500mL) or cyclosporine pills (500mg per 5mL).12,13
