steroid ointment for lichen planus

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Steroid ointment for lichen planus

Although lichen planus often occurs only on cutaneous surfaces, it may also involve the oral mucosa, genital mucosa, scalp, or nails. Lichen planus. Lichen planus on the feet. The reticular white scale of Wickham striae is visible on some of the plaques. Lichen planus on the wrist showing the Koebner phenomenon arrow with linear formations of papules.

Cutaneous lichen planus may present in different forms. Linear lichen planus Figure 3 manifests as closely aggregated linear lesions on the limbs that may develop the Koebner phenomenon. Annular lichen planus Figure 4 accounts for approximately 10 percent of lichen planus cases. In addition to the usual sites of distribution, this form of lichen planus may occur on male genitalia and buccal mucosa. Hypertrophic lichen planus lichen planus verrucosus; Figure 6 usually occurs on the extremities, especially the ankles, shins, and interphalangeal joints, and it tends to be the most pruritic form.

In vesiculobullous lichen planus Figure 7 , vesicles or bullae develop from preexisting lesions on the lower limbs, back, or buttocks, or in the mouth. Atrophic lichen planus on the forearm showing multiple colors within the atrophic lesions. Patients with oral lichen planus often have concomitant manifestations in other extraoral sites. However, the condition is occasionally complicated by extensive painful erosions, leading to a considerable decrease in quality of life.

Sensitivity to heat and a burning sensation may also occur. Intensive therapy is often required to reduce these complications. There are four forms of oral lichen planus: reticular, atrophic, bullous, and erosive. The atrophic form causes atrophic changes with erythema of the oral mucosa. The bullous form manifests as fluid-filled vesicles.

The erosive form leads to ulcerated, painful, erythematous areas that may contract secondary infection, such as candidiasis. These ulcerated areas may have Wickham striae and occur in one or multiple sites of the mouth. Erosive lichen planus of the gums resembles desquamative gingivitis. Malignant transformation has been reported in men with oral erosive lichen planus lesions. Lichen planus affecting the genitalia is more common in men. It typically presents on the glans penis and may have an annular pattern Figure 10 5.

Less commonly, linear, white striae similar to the lesions that typically appear on the vulva and vagina occur on the penis and scrotum. Reticular papules or severe erosions may appear on the vulva and become complicated by urethral stenosis.

Approximately 10 percent of patients with lichen planus present with scalp and nail variants. Scalp lesions lichen planopilaris are violaceous, scaly, pruritic papules that can progress to scarring alopecia if untreated 13 Figure Nail involvement is characterized by irregular, longitudinal grooving and ridging of the nail plate; thinning of the nail plate; nail pterygium i.

Lichen planopilaris causing hair loss with visible dark dots from follicular plugging. Lichen planus can be diagnosed clinically in classic cases, although biopsy is often helpful to confirm the diagnosis and is required for more atypical presentations. A 4-mm punch biopsy should be adequate on the skin or in the mouth. A 4-mm punch biopsy of perilesional skin for direct immunofluorescence may be added to the workup when bullous lesions, pemphigus, or bullous pemphigoid is present.

Tables 2 and 3 present the differential diagnosis of cutaneous and oral lichen planus. Potent topical steroids, oral antipruritic medications, help patient avoid scratching and picking at skin. Cutaneous lichen planus may resolve spontaneously within one to two years, although lichen planus affecting mucous membranes may be more persistent and resistant to treatment.

Recurrences are common, even with treatment. Table 4 summarizes the treatment of nongenital cutaneous lichen planus lesions. High-potency topical corticosteroids are first-line therapy for cutaneous lichen planus. Hypertrophic lesions are treated with intralesional triamcinolone acetonide Kenalog , 5 to 10 mg per mL injection 0.

For severe disease; narrow-band ultraviolet B is preferred over psoralen plus ultraviolet A. Referral to a dermatologist is warranted for patients requiring systemic therapy with acitretin or an oral immunosuppressant. Acitretin Soriatane is an expensive and toxic oral retinoid that is used in more severe cases of cutaneous lichen planus that do not respond to topical treatment.

Acitretin is not approved by the U. Food and Drug Administration FDA for the treatment of lichen planus, and the label includes an FDA boxed warning recommending that it be used only by physicians with experience treating severe psoriasis, prescribing oral retinoids, and handling teratogenic medications. Referral to a dermatologist is warranted for patients with severe lichen planus requiring systemic therapy with acitretin or an oral immunosuppressant.

For genital lichen planus lesions, triamcinolone ointment Triderm is a good firstline agent. Topical tacrolimus Protopic and clobetasol Temovate appear to be effective treatments for vulvovaginal erosive lichen planus. The scarring alopecia of lichen planopilaris is difficult to reverse. A case series showed that topical high-potency corticosteroids and intralesional corticosteroids are commonly used.

Various treatments have been employed to treat symptomatic oral lichen planus, but complete resolution is difficult to achieve. Topical corticosteroids are first-line therapy. Systemic corticosteroids, such as oral prednisone, should be considered only for severe, widespread oral lichen planus and for lichen planus involving other mucocutaneous sites. Clobetasol Temovate Fluocinonide. Fluocinonide 0. Pimecrolimus Elidel Tacrolimus Protopic. Tacrolimus 0.

Generic price listed first; brand price listed in parentheses. Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus Elidel , are second-line therapies for oral lichen planus. In a randomized controlled trial, aloe vera gel was significantly more effective than placebo in the clinical and symptomatologic improvement of oral lichen planus.

Already a member or subscriber? Log in. At the time this article was written, she was a resident at the University of Texas Health Science Center. Address correspondence to Richard P. Usatine, MD, at usatine uthscsa. Reprints are not available from the authors.

Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci. A systematic review of placebo-controlled randomized clinical trials of treatments used in oral lichen planus. Br J Dermatol. Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis. Arch Dermatol. Lichen planus and hepatitis C virus infection: an epidemiologic study.

Int J Clin Pract. Kraft R, Usatine RP. Katta R. Lichen planus [published correction appears in Am Fam Physician. Am Fam Physician. Andrews' Diseases of the Skin: Clinical Dermatology. Philadelphia, Pa. Eisen D.

The evaluation of cutaneous, genital, scalp, nail, esophageal, and ocular involvement in patients with oral lichen planus. Dissemond J. Oral lichen planus: an overview. J Dermatolog Treat. Current controversies in oral lichen planus: report of an international consensus meeting. Part 2. Clinical management and malignant transformation.

Unexpectedly high frequency of genital involvement in women with clinical and histological features of oral lichen planus. Acta Derm Venereol. Prevalence of vulval lichen planus in a cohort of women with oral lichen planus: an interdisciplinary study. A case-series of 29 patients with lichen planopilaris: the Cleveland Clinic Foundation experience on evaluation, diagnosis, and treatment. J Am Acad Dermatol. Treatment of lichen planus.

An evidence-based medicine analysis of efficacy. Comparative effect of tacrolimus 0. J Clin Periodontol. Topical clobetasol in the treatment of atrophic-erosive oral lichen planus: a randomized controlled trial to compare two preparations with different concentrations. J Oral Pathol Med. Patient satisfaction after the treatment of vulvovaginal erosive lichen planus with topical clobetasol and tacrolimus: a survey study. Am J Obstet Gynecol. Efficacy of aloe vera gel in the treatment of vulval lichen planus.

J Coll Physicians Surg Pak. A randomized controlled trial to compare topical cyclosporin with triamcinolone acetonide for the treatment of oral lichen planus. Fluocinonide in an adhesive base for treatment of oral lichen planus. A double-blind, placebo-controlled clinical study. A comparative treatment study of topical tacrolimus and clobetasol in oral lichen planus. The efficacy of aloe vera gel in the treatment of oral lichen planus: a randomized controlled trial. CO2 laser evaporation of oral lichen planus.

Int J Oral Maxillofac Surg. This content is owned by the AAFP. Although many patients with OLP remain asymptomatic, some experience periods of marked inflammation with breakdown of the lesions, and require treatment. Corticosteroids are the mainstay of treatment for oral lesions, but delivery to affected mucosal sites can be problematic.

The purpose of this study was to retrospectively review the results of topical steroid therapy in a group of patients with OLP, using a novel delivery method. The records of 33 patients with biopsy-proven OLP were reviewed and the relevant clinical features were noted at minimum review intervals of one, six and 12 months.

Of this group, 24 patients had been treated using a standardized treatment protocol consisting of a corticosteroid ointment applied topically to mucosal lesions using cloth strips. Gingival lesions were treated using a steroid preparation in an adhesive paste. Nine patients remained asymptomatic and were not treated.

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Jump to navigation. Are corticosteroids effective and safe for the treatment of oral lichen planus that is causing pain? Usual treatment is with drugs known as corticosteroids applied directly to the painful areas topically , or taken internally systemically.

Treatment aims to reduce pain and improve healing of the mouth, but there is no cure for the disease. We included 35 randomised controlled trials clinical studies where people are randomly put into one of two or more treatment groups with participants, which tested several different corticosteroids, mostly delivered topically on the skin.

Corticosteroids were compared with one of the following: a placebo a treatment that resembled the corticosteroid but had no active ingredient ; a medicine from a category called calcineurin inhibitors; another medicine type; another corticosteroid or mode of delivery; the same corticosteroid plus an extra treatment; or an alternative treatment.

Treatments were given for between one week and six months, with side effects measured throughout the treatment, and pain and healing measured at the end of treatment. Results from two studies showed that topical corticosteroids e. We do not have the evidence that topical corticosteroids can eliminate the oral lichen planus lesions, and we are uncertain about side effects.

Three studies using another topical medicine called tacrolimus a calcineurin inhibitor found that this medicine may be more effective than corticosteroids, but may be more likely to cause mild side effects. The reliability of most of the evidence is very low, so we cannot be sure about the findings and future research may lead us to different conclusions. The available evidence suggests that topical corticosteroids may be effective for treating painful oral lichen planus, but our confidence in these findings is limited as there were only a small number of studies and participants.

Actually, there are no fluocinonide preparations specifically designed for the mouth that I know of. The concerns from patients who carefully read the manufacturers' instructions are legitimate and I personnally find it refreshing to see that some people actually read them! The practice is widespread within the profession, supported by litterature, and quite effective in many cases albeit often not definitive.

Oral lichen planus is sometimes refractory, and many treatments of various potency may need to be tried before finding one that suits a particular patient. I would say that the most important is to follow the treatment modalities recommendend by the dentist and consult an oral medicine specialist when all topical treatment options fail as there are systemic treatment options available.

Severe oral lichen planus can be quite debilitating. I've been trying just about everything. I've suffered OLP for about 6 years What I'm trying now and it has worked wonders is Turmeric Curcumin, mg. It is kind of hard to find high grade turmeric in drug stores, so I buy it through Amazon.

I take a minimum of mg per day. If I'm eating 3 meals a day, I will push it to mg. You need to get it to a therapeutic level to do any real good. It's treatment is for inflammation. If you can control inflammation in your mouth, you're close to winning the battle vs. Still no cure, but it goes a long ways for relief.

I started seeing results after about weeks. I will continue to take turmeric, as it has helped me more then anything. My brother is a dentist. I have visited 3 different oral surgeons and a couple of dermatologists They actually have a Lichen Planus Department. Oddly enough, a lot of dentist know very little about OLP. Don't be afraid of it It may burn like heck, but it's not going to end your life Good Luck, everyone! I am new to this disease and have been dealing with it by brushing and using a waterpic as well as Zero Listerine swishes 3 times a day and it becomes almost pain free.

I do have to eat more on one side as it hurts less on that side and eat softer food. Does this get more painful with time? I started making my own toothpaste to help with pain. Even the violence burns. My doc gave me viscous lidocaine to swish when it gets bad. For toothpaste I use Hello Kitty bubblegum toothpaste recommended by my dentist.

It has no pain while brushing. As I follow-up my LP, I was sent to a rheumatologist and put on methrotrexate, a chemo pill. I take 20mg a week and it has almost put this disease into remission. All the oral bumps, etc. My skin started to take a change in color shortly after a trip from Hawaii last year.

I when to see a doctor, and was diagnosed with a condition called Lichen plants and was prescribed Fluocinonide USP,0. I used it for my arms, nice, and chest for two months. The condition did not improved. Could it be I was prescribed with incorrect medication or wrong diagnosis? I was prescribed fluocinonide for oral lichen planus a few years ago.

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We do not have the evidence that topical corticosteroids can eliminate the oral lichen planus lesions, and we are uncertain about side effects. Three studies using another topical medicine called tacrolimus a calcineurin inhibitor found that this medicine may be more effective than corticosteroids, but may be more likely to cause mild side effects.

The reliability of most of the evidence is very low, so we cannot be sure about the findings and future research may lead us to different conclusions. The available evidence suggests that topical corticosteroids may be effective for treating painful oral lichen planus, but our confidence in these findings is limited as there were only a small number of studies and participants.

There is some evidence that tacrolimus may be more effective than a corticosteroid, but evidence on negative side effects is inconclusive. Read the full review. Interventions for treating oral lichen planus: corticosteroid therapies.

Cochrane Database of Systematic Reviews , Issue 2. DOI: Cochrane Library Cochrane. Corticosteroids for treating oral lichen planus. Key results Results from two studies showed that topical corticosteroids e. Kraft R, Usatine RP. Katta R. Lichen planus [published correction appears in Am Fam Physician. Am Fam Physician.

Andrews' Diseases of the Skin: Clinical Dermatology. Philadelphia, Pa. Eisen D. The evaluation of cutaneous, genital, scalp, nail, esophageal, and ocular involvement in patients with oral lichen planus. Dissemond J. Oral lichen planus: an overview. J Dermatolog Treat. Current controversies in oral lichen planus: report of an international consensus meeting. Part 2.

Clinical management and malignant transformation. Unexpectedly high frequency of genital involvement in women with clinical and histological features of oral lichen planus. Acta Derm Venereol. Prevalence of vulval lichen planus in a cohort of women with oral lichen planus: an interdisciplinary study.

A case-series of 29 patients with lichen planopilaris: the Cleveland Clinic Foundation experience on evaluation, diagnosis, and treatment. J Am Acad Dermatol. Treatment of lichen planus. An evidence-based medicine analysis of efficacy. Comparative effect of tacrolimus 0. J Clin Periodontol. Topical clobetasol in the treatment of atrophic-erosive oral lichen planus: a randomized controlled trial to compare two preparations with different concentrations. J Oral Pathol Med.

Patient satisfaction after the treatment of vulvovaginal erosive lichen planus with topical clobetasol and tacrolimus: a survey study. Am J Obstet Gynecol. Efficacy of aloe vera gel in the treatment of vulval lichen planus. J Coll Physicians Surg Pak. A randomized controlled trial to compare topical cyclosporin with triamcinolone acetonide for the treatment of oral lichen planus.

Fluocinonide in an adhesive base for treatment of oral lichen planus. A double-blind, placebo-controlled clinical study. A comparative treatment study of topical tacrolimus and clobetasol in oral lichen planus. The efficacy of aloe vera gel in the treatment of oral lichen planus: a randomized controlled trial. CO2 laser evaporation of oral lichen planus. Int J Oral Maxillofac Surg. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere?

Get Permissions. Read the Issue. Sign Up Now. Previous: Management of Acute Asthma Exacerbations. Next: Outpatient Approach to Palpitations. Jul 1, Issue. Diagnosis and Treatment of Lichen Planus. B 14 — 16 Topical calcineurin inhibitors, such as tacrolimus Protopic and pimecrolimus Elidel , should be used as second-line therapies to treat genital and oral lichen planus. B 15 , 17 , 21 Intralesional triamcinolone acetonide Kenalog , 5 to 10 mg per mL injection, should be used to treat hypertrophic lichen planus.

B 14 Three to six weeks of oral prednisone therapy should be used to treat severe, widespread lichen planus tapered course, 30 to 60 mg per day starting dose. Enlarge Print Table 1. Table 1. Enlarge Print Figure 1.

Lichen planus with papules and plaques on the wrist. Figure 1. Enlarge Print Figure 2. Figure 2. Enlarge Print Figure 3. Usatine, MD. Figure 3. Enlarge Print Figure 4. Annular lichen planus on the breast. Figure 4. Enlarge Print Figure 5. Figure 5. Enlarge Print Figure 6. Hypertrophic lichen planus on the leg.

Figure 6. Enlarge Print Figure 7. Bullous lichen planus on the buttocks. Figure 7. Enlarge Print Figure 8. Oral lichen planus with Wickham striae on buccal mucosa. Figure 8. Enlarge Print Figure 9. Oral lichen planus with erosions on the lips, tongue, and palate. Figure 9. Enlarge Print Figure Lichen planus on the penis showing a lacy, white, annular pattern. Figure Enlarge Print Table 2. Table 2. Enlarge Print Table 3. Differential Diagnosis of Oral Lichen Planus Condition Distinguishing features Diagnostic method Treatment Bite trauma White area on buccal mucosa where the teeth occlude Clinical appearance Reassurance Leukoplakia White adherent patch or plaque on oral mucosa that does not rub off Punch or shave biopsy Surgical excision or cryotherapy with liquid nitrogen Thrush White adherent patch or plaque on oral mucosa that rubs off Clinical appearance and potassium hydroxide KOH preparation Antifungal suspension or troches.

Table 3. Enlarge Print Table 4. Table 4. Enlarge Print Table 5. Table 5. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close. Best Value! To see the full article, log in or purchase access. Author disclosure: No relevant financial affiliations to disclose. More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue.

Sign up for the free AFP email table of contents. Navigate this Article. Excoriations and lichenification of skin, often on flexor surfaces. Topical steroids and emollients. Lichen simplex chronicus. One or more plaques with lichenification in an area that is easily scratched. Potent topical steroids; help patient avoid scratching and picking at skin. Herald patch preceding annular plaques with collarette scale.

Reassurance self-limited condition. Pruritic nodules, often on the extremities. Plaques with thick scale on extensor surfaces. Potent topical steroids, topical vitamin D, other treatments.

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LICHEN PLANUS - EXPLAINED IN 3 MINUTES - ETIOLOGY, SYMPTOMS, TREATMENT

Bullous lichen planus on the. Interventions for treating oral lichen. Enlarge Print Figure 9. J Coll Physicians Surg Pak. Cochrane Database of Systematic Reviews. Corticosteroids for treating oral lichen. Oral lichen planus with erosions. Vaginal stenosis did not significantly. Enlarge Print Figure 4. Hypertrophic lichen planus on the.

The first-line treatments of cutaneous lichen planus are topical steroids, particularly class I or II ointments. Topical corticosteroids are the mainstay of medical treatment of oral lichen planus (OLP), although rarely, corticosteroids may be. High-potency topical corticosteroids are first-line therapy for all forms of lichen planus, including cutaneous, genital, and mucosal.