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Treatments and drugs
By Mayo Clinic staffOral lichen planus is a chronic condition that can be difficult to manage. The treatment goals are to help severe lesions heal and to lessen pain or other discomfort. Your doctor will monitor your condition to increase or decrease dosages, change medications or stop treatment as necessary.
If you have no pain or discomfort and if only white, lacy lesions are present, you may not need any treatment.
Corticosteroids
Corticosteroids may reduce inflammation associated with oral lichen planus. The side effects vary depending on whether it's used as a mouthwash or ointment applied directly to the mucous membrane (topical), taken as a pill (oral), or administered as an injection. The potential benefit of corticosteroids needs to be balanced with possible side effects, which include the following:
- Topical. Topical corticosteroids to treat oral lichen planus may result in oral thrush, an infection caused by the Candida albicans fungus. If this infection occurs, you'll need to take an antifungal medication. Long-term use of topical corticosteroids may also cause suppression of adrenal gland function and a lessening of the treatment effect.
- Oral. Long-term use of oral corticosteroids can cause weakening of the bones (osteoporosis), diabetes, high blood pressure, high cholesterol and other serious side effects.
- Injections. Injections may be administered directly into lesions. Repeated use of corticosteroid injections can cause some of the same side effects as oral corticosteroids.
Retinoids
Retinoids are synthetic versions of vitamin A that can be applied as a topical ointment or taken orally. The topical treatment doesn't cause the same side effects associated with corticosteroids, but it may irritate the mucous membranes of your mouth.
Because both topical and oral retinoids can cause birth defects, the drug shouldn't be used by women who are pregnant or planning to become pregnant in the near future. Your doctor can advise you on necessary precautions.
Nonsteroidal ointments
In the past few years, several reports have shown the effectiveness of topical medications, called calcineurin inhibitors, which are closely related to or identical to oral medications used to prevent rejection of transplanted organs. These treatments appear to be effective for the treatment of oral lichen planus. Examples of these topical medications include tacrolimus (Protopic ointment) and pimecrolimus (Elidel cream).
Addressing triggers
If your doctor suspects that oral lichen planus may be related to a drug you take, hepatitis C infection, an allergen or stress, he or she will recommend steps to address the trigger. These actions may include the following:
- Drugs. Your doctor may ask you to stop taking a drug or to try an alternative drug to the one that may be acting as a trigger. This action may require consultation with the doctor who originally prescribed your medication.
- Hepatitis C. You'll likely be referred to a specialist in infectious diseases or a specialist in liver disease (hepatologist) for further diagnostic evaluation and disease management.
- Allergen. If tests suggest that an allergen may be a potential trigger, you'll be advised to avoid the allergen, and you may need to see a dermatologist or an allergist for additional treatment. If a dental device is a suspected allergen, you may need to see your dentist to have dental materials extracted and replaced.
- Stress. Because stress may be a factor that complicates symptoms or triggers the recurrence of symptoms, you may need to develop skills to avoid or manage stress. Your doctor may refer you to a psychotherapist, psychiatrist or other specialist in mental health care who can help you identify stressors, develop stress management strategies or address other mental health care concerns.
- Lichen planus. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec10/ch116/ch116g.html. Accessed May 21, 2010.
- Eisen D. The clinical manifestations and treatment of oral lichen planus. Dermatologic Clinics. 2003;21:79.
- Lehman JS, et al. Lichen planus. International Journal of Dermatology. 2009;48:682.
- Farhi D, et al. Pathophysiology, etiologic factors, and clinical management of oral lichen planus. Part I: Facts and controversies. Clinics in Dermatology. 2010;28:100.
- Gibson LE (expert opinion). Mayo Clinic, Rochester, Minn. May 31, 2010.
- Psoriasis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Psoriasis/default.asp. Accessed April 18, 2010.
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