Lichen Planus

K Pavithran

 Department of Dermato-Veneorology, Malabar Institute of Medical Sciences (MIMS), Colicut-673 006, India

Correspondence Address:
K Pavithran
Department of Dermato-Veneorology, Malabar Institute of Medical Sciences (MIMS), Colicut-673 006
India

The management of lichen planus (LP) depends on the age of the patient, site affected and type of LP General measures include application of emollients, and avoidance of soap, if the patient has dry skin. Nails should be cut short.

Wide spread lesions are treated with a short course of systemic corticosteroid (Prednisolone 20 to 30 mg daily for x 7 days, 10 mg daily x 7 days, alternate days for 14 days and then 5mg altenate days for 14 days). Those who cannot be given steroid daily I give steroid mini pulse (Prednisolone 40 mg daily x 3 consecutive days a week x 6-8 weeks only). Along with this, topical potent steroid (clobetasol propionate) also is prescribed for twice daily application. Oral antihistamine (Pheniramine maleate or cetirizine) is given to control pruritus. For children, less potent steroid (clobetasone, fluticasone or mometasone) is preferred for topical use.

For hypertrophic LP intralesional triamcinolone acetonide 10mg/mI is injected at intervals of 2 to 3 weeks. For extensive hypertrophic lesions affecting only the extremities I prefer topical potent corticoid and occlusive dressing (apply ointment first, then cover it with a polythene paper and then give bandage with a cloth. This can be removed after 8 to 12 hours. For the treatment of oral LP triamcinolone (oralbase) is to be applied twice daily (after breakfast and before going to bed at night). Keep it over the lesion for 20 minutes and then can be swallowed. If oral lesions (especially plaques) do not respond to topical treatment, intralesional triamcinolone acetonide 10mg/ml. is injected once in 3 weeks. Patient is advised to avoid tooth brush, hot and spicy food and smoking. Sharp tooth if any, is to be ground and smoothened.

LP lesions on healing, leaves hyperpigmented macules. These are treated with a topical preparation containing clobetasol propionate and lotio calamine.

If hypertrophic lesions ulcerate, or oral erosions ulcerate or feel indurated, a biopsy is to be done from the affected site to exclude malignant change.