Lichen Planus — SCE Dermatology MCQ

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ModerateInflammatory DermatosesLichen PlanusSCE Dermatology

A 50-year-old woman presents with widespread lichen planus. She has involvement of the skin, oral mucosa, and nails. She has not responded to potent topical corticosteroids and phototherapy. What systemic treatment is first-line for refractory lichen planus?

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Correct answer: B — Oral Hydroxychloroquine

For lichen planus not responding to topical therapy and phototherapy, Hydroxychloroquine (200-400 mg daily) is considered a first-line systemic agent, particularly for oral and cutaneous LP. It has both immunomodulatory and anti-inflammatory properties. Retinoids (Acitretin) may be effective for cutaneous LP but can worsen oral LP. Methotrexate and Mycophenolate are second-line options. Ciclosporin can be used for short-term rescue of severe erosive disease. For isolated erosive oral LP, topical corticosteroids (Betamethasone soluble tablets used as mouthwash, or Clobetasol gel) and topical Tacrolimus are first-line before systemic therapy.

Reference: BAD 2019 Lichen Planus Guidelines; NICE