What Is The Best Treatment For Lichen Planus?
Regarding treatment of lichen planus skin disease, doctors should start by identifying and controlling the contributing factors:
- Eliminate Local, Mechanical, Physical, Chemical and Biological Factors That May Be Involved: This is a mandatory phase prior to the pharmacological treatment. With it, doctors can control an important part of the symptoms and signs of the lichen planus disease. The dental edges should be polished, the sharp edges should be removed and any injuries should be removed (if necessary, dental extractions). The prostheses should be tight. It is important to eliminate dental plaque by perfecting oral hygiene, as this will only improve gingival erythematous lesions. As with all patients, it is advisable to eliminate tobacco and alcohol consumption and establish an adequate diet.
- Intake of Drugs That Can Produce Lichenoid Reaction: If it is suspected as the cause of oral lichenoid lesions, the responsible drug responsible should be suppressed or changed.
- Control The Underlying Systemic Disease: Doctors investigate liver diseases (hepatitis C), diabetes, control stress and anxiety as well as hypertension.
The conventional treatment of lichen planus is based on the application of corticosteroids as a basic medication to control inflammatory activity:
The most commonly used topical corticosteroids are (from lowest to highest anti-inflammatory power):
- 0.1-0.3% triamcinolone acetonide
- Fluocinolone Acetonide 0.05% -0.1%
- Clobetasol propionate 0.025-0.05%
The choice of topical corticosteroid and the administration regimen will be made according to the severity of the lichen planus lesions and their extension.
Some of these topical corticosteroid therapies may predispose the patient to candidiasis (it is a disease caused by a fungus), which is why topical antifungals are usually prescribed as a preventive treatment or when the infection has been established.
Topical corticosteroids are a pillar in the lichen planus treatment, but if the patient is facing an erosive oral lichen planus (OLP) that does not respond, some experts recommend the use of topical tacrolimus or topical cyclosporine. However, the latter has produced contradictory results, due to its lack of mucosal penetration.
Systemic Corticosteroids: They are indicated mainly in the following situations:
- If there are lichen planus lesions in other mucous sites (genitals, esophagus).
- If the topical route has not been effective.
- If there are no contraindications for its use.
The use of prednisone at a dose of 1-1.5 mg/kg of weight daily in a single dose in the early morning is recommended. This dose is used for 2-3 weeks and then with the same doses every other day or gradually decreasing.
Intralesional Corticosteroids: Its use is limited to treating lichen planus lesions that are very localized and/or resistant to other treatments.
Depot preparations of triamcinolone acetonide (30 mg) or betamethasone acetate (6 mg) are used, which are injected perilesionally once a week for 2-4 weeks for lichen planus.
In patients who have not improved their lichen planus lesions with corticosteroids, alternative treatments should be considered as hydroxychloroquine, azathioprine, mycophenolate, dapsone or retinoids. Current immunosuppressive therapies generally control erythema, ulceration, and oral symptoms in patients with oral lichen planus with minimal unwanted effects.
In general, asymptomatic reticular lesions, if they are not widespread, do not require therapy, only observation for changes.
Lichen planus in plaques should be approached with a more radical behavior, such as replacing the classic drug-therapeutic treatment with conservative surgical treatment, thus preventing possible onco conversion.
It is important to inform patients that oral lichen planus lesions can persist for many years with periods of exacerbation and remission. The periodic control must be carried out at least every six months.
It is advisable to evaluate patients with oral lichen planus every month during active treatment and to supervise the lesions until the reduction of erythema and ulceration. Active treatment should continue until the erythema, ulceration, and symptoms are controlled.
Current treatments for lichen planus try to control outbreaks of inflammatory activities and avoid complications, but treatments are empirical and little is known about the effects of other drugs, diet, physical exercise, relaxation techniques and new drugs with anti-inflammatory activity or immunomodulatory. There is no totally effective treatment for this disease. Molecular biology, genomics, and proteomics open new paths.
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