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Lichen planus - the evidence-base for treatment

Latest in the series offering evidence-based advice not covered by official guidelines.

Latest in the series offering evidence-based advice not covered by official guidelines.

Aetiology

The aetiology is unknown.

Clinical features

• Bluish-red, flat, glistening, polygonal papules with a pale mesh-like surface (Wickham striae).

• Some of the papules may have bullae.

• Lesions on the legs may become hypertrophic.

• On the mouth mucosa, a pale mesh-like surface is typical and it may ulcerate.

• The Koebner phenomenon: scratches on the skin become affected with papules.

• Typical sites include the volar fold of the wrist, flexor surfaces of the arms and the ankle.

• Common sites also include the proximal palms, soles, lower lip and glans penis.

• Papules are often distributed on the trunk, especially in the sacral area.

• The lesions are almost invariably itchy.

Diagnostics

• The clinical presentation is usually sufficient for diagnosis.

• Skin biopsy is diagnostic.

Treatment

• An alternative to all modes of treatment is to wait for spontaneous recovery. There is no predictable time course for spontaneous healing.

• Potent steroid preparations often clear the lesions in a couple of weeks.

• Do not use potent steroids without controlling for the outcome.

• Lichen planus on the oral mucosa is difficult to treat. Steroids (level of evidence=C), retinoids, cyclosporin (C) or sometimes cryotherapy may be of benefit. The possible irritating or sensitising effect of amalgam fillings may be worth considering.

• Do not treat pigmented remnants of lichen papules. They return to normal colour spontaneously with time.

• If widespread, active lichen planus is not cured by local treatments – a dermatologist may consider acitretin (B), griseofulvin, cyclosporin or PUVA.

• The disease recurs in at least 50% of patients – often after a few years.

Levels of evidence

A high

B moderate

C low

D very low

This synopsis is taken from EBM Guidelines, a collection of treatment and diagnosis guidelines supported by evidence summaries.

© Duodecim Medical Publications. Distributed by Wiley-Blackwell.

For more information, email burquhart@wiley.co.uk or visit ebmg.wiley.com

Lichen planus Lichen planus

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