Once leukoplakia has been ruled out, what are the preferred treatments for oral lichen planus?
—Chris Moran, MSN, CRNP, Southampton, Pa.
Once the diagnosis has been confirmed, therapy includes medical treatment and the minimization of precipitating factors (e.g., eliminate tobacco and alcohol, improve oral hygiene, stop cheek biting and tongue thrusting, and correct or remove sharp tooth cusps, fractured restorations, and poorly fitting prostheses). For mild cases, topical agents include anesthetics, such as viscous lidocaine 5% solution, tretinoin 0.1% gel, and corticosteroids, such as clobetasol 0.05% gel or betamethasone dipropionate 0.05% gel. Intralesional corticosteroids can also be used.
For moderate disease, interventions include topical cyclosporine, systemic antimalarials (hydroxychloroquine or chloroquine), and topical tacrolimus. For severe disease, systemic immunosuppressants and immunomodulating agents (azathioprine, cyclophosphamide, cyclosporine, interferon-a, levamisole, methotrexate, mycophenolate mofetil, and thalidomide), systemic retinoids (acitretin, isotretinoin, and tretinoin), other agents (enoxaparin and phenytoin), and intra-oral psoralen plus UVA radiation have been used. Antifungal medications may be helpful for secondary candidiasis (Dermatol Clin. 2003;21:79-89 and Skinmed. 2002;1:52-53).
—Philip R. Cohen, MD (105-4)