Treatment of Oral Lichen Planus

First-Line Therapy

The National Comprehensive Cancer Network recommends high-potency topical corticosteroids, such as clobetasol 0.05% or fluocinonide 0.05%, as the first-line treatment for oral lichen planus, with gel formulations preferred for mucosal disease 1
Treatment with high-potency topical corticosteroids should continue until symptoms improve to Grade 1, followed by a tapering schedule over 3 weeks 1
Tacrolimus 0.1% ointment is recommended as an alternative first-line treatment for all grades of oral lichen planus 1

For moderate to severe oral lichen planus that doesn't respond to topical treatments, the National Comprehensive Cancer Network recommends considering oral antihistamines for symptomatic relief of pruritus 1
Systemic corticosteroids, such as prednisone, may be considered for more severe cases of oral lichen planus 1
Narrow-band UVB phototherapy may be considered if available 1

Biopsy is mandatory before initiating treatment to confirm diagnosis and rule out malignancy, particularly squamous cell carcinoma 2
Treatment should address any potential triggers, including immune dysregulation factors, potential infectious triggers, and trauma and injury to oral tissues 2

The management algorithm for oral lichen planus involves confirming diagnosis with biopsy, assessing severity of symptoms, and starting with high-potency topical corticosteroids or tacrolimus 0.1% ointment for mild to moderate symptoms 1
For moderate to severe symptoms, oral antihistamines and short-course systemic corticosteroids may be added 1
Regular follow-ups are scheduled to monitor response and assess for malignant transformation 2