Guideline sources The following summarized guidelines for the management of lichen planus are prepared by our editorial team based on guidelines from the European Academy of Dermatology and Venereology (EADV/EDF 2020), the Royal College of Ophthalmologists (RCOphth 2020), and the European Academy of Dermatology and Venereology (EADV 2017). 1 2 3 Guidelines 1. Medical management Management of cutaneous lichen planus: Offer the following as first-line therapy in patients with cutaneous lichen planus: topical corticosteroids (superpotent and potent such as triamcinolone acetonide, fluocinolone acetonide, betamethasone dipropionate and clobetasol propionate) intralesional triamcinolone, especially for more hypertrophic or unresponsive lesions (5-20 mg/mL every 2-4 weeks) systemic corticosteroids (oral or IM injections) If lesions are unresponsive to topical treatment (oral prednisone of 30-80 mg/day for 4-6 weeks or IM injections of triamcinolone 40-80 mg every 6-8 weeks) acitretin (20-35 mg/day) or isotretinoin oral cyclosporine (3-5 mg/kg/day). E Show 2 more https://web.pathway.md/diseases/recscqyrydNz56Y6l 1/3 6/29/23, 5:52 AM Lichen planus Pathway Management of oral lichen planus: Offer the following as first-line therapy in patients with oral lichen planus: topical corticosteroids (clobetasol propionate 0.05%, triamcinolone, betamethasone, fluocinonide, fluticasone, dexamethasone and prednisolone in different forms) intralesional corticosteroids (triamcinolone acetonide hydrocortisone, dexamethasone and methylprednisolone) in patients with ulcerative oral lichen planus oral systemic corticosteroids, methylprednisolone or prednisone (30-80 mg/day) systemic retinoids, such as acitretin (25-50 mg/day) initially, followed by isotretinoin (0.5-1 mg/kg/day) topical retinoids (isotretinoin 0.05-0.1%) or other forms of vitamin A derivatives for white lesions oral cyclosporine (3-10 mg/kg/day). E Show 2 more Management of genital lichen planus: As per EDF 2020 guidelines: Offer hydrocortisone acetate 25 mg rectal suppositories inserted in the vagina nightly or 1 g clobetasol or another potent topical corticosteroid ointment in patients with genital lichen planus. E Consider offering the following in patients with genital lichen planus: calcineurin inhibitors (tacrolimus, pimecrolimus) local anesthetic gel sedating antihistamines low-dose TCAs or anticonvulsants. E As per EADV 2017 guidelines, offer ultrapotent topical corticosteroids such as clobetasol propionate in patients with vulvar lichen planus. B Show 4 more Management of appendageal lichen planus: Offer the following as first-line therapy in patients with appendageal lichen planopilaris: topical corticosteroids (superpotent, potent, mild) intralesional corticosteroids (such as triamcinolone 5-20 mg/mL every 2-4 weeks) systemic corticosteroids (30-80 mg/day of prednisone) systemic cyclosporine (3-10 mg/kg/day) hydroxychloroquine sulfate (200-400 mg/day or 6.5 mg/kg per day for 6-12 months) methotrexate (15 mg/weekly for 6 months) topical calcineurin inhibitors (primarily tacrolimus). E Show 2 more 2. Follow-up and surveillance Follow-up: https://web.pathway.md/diseases/recscqyrydNz56Y6l 2/3 6/29/23, 5:52 AM Lichen planus Pathway Obtain careful monitoring for all potentially toxic therapies (such as azathioprine, dapsone, griseofulvin, chloroquine, minocycline, cyclosporine, methotrexate, mycophenolate, retinoids, oral corticosteroids) preferably supervised by a dermatologist at a specialized clinic. B Assess active disease as clinically required. Ensure long-term specialized follow-up in patients with erosive vulvar lichen planus. B Monitoring for chloroquine/hydroxychloroquine retinopathy: obtain annual monitoring for retinopathy in all patients receiving hydroxychloroquine for > 5 years or chloroquine for > 1 year. B Show 17 more References 1. D Ioannides, E Vakirlis, L Kemeny et al. European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology. J Eur Acad Dermatol Venereol. 2020 Jul;34 7 1403 1414. Open 2. The Royal College of Ophthalmologists. Hydroxychloroquine and Chloroquine Retinopathy: Recommendations on Monitoring. RCOphth. 2020 Dec. Open 3. van der Meijden WI, Boffa MJ, Ter Harmsel WA et al. 2016 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol. 2017 Jun;31 6 925 941. Open https://web.pathway.md/diseases/recscqyrydNz56Y6l 3/3