First-line treatment for managing lichen planus in adults primarily involves the use of potent topical corticosteroids. These agents are considered the most effective and safest initial therapy, particularly for localized disease manifestations, including oral and cutaneous lichen planus. Topical corticosteroids help reduce inflammation and control symptoms effectively.
Topical calcineurin inhibitors (such as tacrolimus and pimecrolimus) are recommended as an alternative first-line option, especially for sensitive areas like the face, mucous membranes, or where corticosteroid-induced skin atrophy is a concern. They offer a better short-term safety profile and can be particularly useful for oral lichen planus or lesions on thin skin.
Systemic corticosteroids or other systemic immunosuppressants are generally reserved for more extensive, refractory, or rapidly progressive cases and usually require specialist referral.
This approach aligns with expert consensus and recent literature emphasizing corticosteroid therapies as the cornerstone of lichen planus management, with calcineurin inhibitors as valuable alternatives or adjuncts in specific clinical scenarios.
Overall, the treatment strategy should be individualized based on disease severity, site involvement, and patient tolerance, with specialist input for complex cases.
References: NICE CKS; Lodi et al. 2020; Louisy et al. 2024; Iorizzo et al. 2020
Key References
- CKS - Vitiligo
- CKS - Psoriasis
- CKS - Alopecia areata
- CKS - Pityriasis rosea
- CG153 - Psoriasis: assessment and management
- (Lodi et al., 2020): Interventions for treating oral lichen planus: corticosteroid therapies.
- (Iorizzo et al., 2020): Isolated nail lichen planus: An expert consensus on treatment of the classical form.
- (Louisy et al., 2024): Oral Lichen Planus: An Update on Diagnosis and Management.