Treatments and drugsBy Mayo Clinic staff
Oral lichen planus is a chronic condition, so the treatment goals focus on helping severe lesions heal and reducing 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. For more severe symptoms, you may need one or more of the options below.
Treatments such as topical numbing agents can be used to provide temporary relief for areas that are particularly painful.
Corticosteroids may reduce inflammation related to oral lichen planus. Side effects vary, depending on whether corticosteroids are used as a mouthwash, ointment or gel applied directly to the mucous membrane (topical), given as an injection directly into the lesion, or taken as a pill (oral). Topical is the preferred method for corticosteroid use with oral lichen planus. Talk with your doctor to weigh the potential benefits against possible side effects.
Retinoids are synthetic versions of vitamin A that can be applied as a topical ointment or taken orally, but they're not commonly used to treat oral lichen planus. Topical treatment 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.
Immune response medicines
Medications that suppress or modify your body's immune response may be used as ointments, gels or oral medication. Treatments that suppress immune system abnormalities may improve more severe lesions and lessen pain.
For example, 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. However, packaging for these medications carries a Food and Drug Administration (FDA) warning because of an unclear association with cancer. Examples of these topical medications include tacrolimus (Protopic) and pimecrolimus (Elidel).
For severe cases where oral lichen planus also involves other areas — such as the scalp, genitalia or esophagus — systemic medications that suppress the immune system may be used. However, these are seldom used for oral lichen planus unless other parts of the body also are affected.
Dealing with triggers
If your doctor suspects that oral lichen planus may be related to a drug you take, or to a hepatitis C infection, an allergen or stress, he or she will recommend how to address the trigger. These actions may include:
- Drugs. Your doctor may ask you to stop taking a drug that can be a trigger or to try another drug instead. This may require discussion 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. You may need to see a dermatologist or an allergist for additional testing, such as allergy skin patch testing. If a dental device is a suspected allergen, you may need to see your dentist to have dental materials removed and replaced.
- Limiting oral trauma. Performing gentle oral cleaning and choosing foods that are soft may help limit the discomfort associated with oral lichen planus.
- Stress. Because stress may complicate symptoms or trigger symptom recurrence, you may need to develop skills to avoid or manage stress. Your doctor may refer you to a mental health specialist who can help you identify stressors, develop stress management strategies or address other mental health concerns.
- Lichen planus. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec10/ch116/ch116g.html. Accessed Feb. 4, 2013.
- Patil A, et al. Oral bullous lichen planus: Case report and review of management. Contemporary Clinical Dentistry. 2012;3:344.
- 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.
- Brewer JD, et al. Lichen planus and cicatrical conjunctivitis: Disease course and response to therapy of 11 patients. Journal of the European Academy of Dermatology and Venereology. 2011;25:100.
- Lichen planus. American Academy of Dermatology. http://www.aad.org/skin-conditions/dermatology-a-to-z/lichen-planus/lichen-planus. Accessed Feb. 4, 2013.
- Gibson LE (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 8, 2013.
- Bruce AJ (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 25, 2013.