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Oral Lichen Planus Medication

  • Author: Philip B Sugerman, MDS, PhD; Chief Editor: William D James, MD  more...
 
Updated: Sep 21, 2015
 

Medication Summary

Topical corticosteroids are the mainstay of medical treatment of oral lichen planus, although rarely, corticosteroids may be administered intralesionally or systemically. Some topical corticosteroid therapies may predispose the patient to oral pseudomembranous candidosis. However, this condition is rarely if ever symptomatic, and it generally does not complicate healing of the erosions related to oral lichen planus. Topical antimycotics (eg, nystatin, amphotericin) may be prescribed when an infection is present.

Erosive oral lichen planus that is recalcitrant to topical corticosteroids may respond to topical tacrolimus.[32] Other potential therapies for recalcitrant oral lichen planus include hydroxychloroquine, azathioprine, mycophenolate, dapsone, systemic corticosteroids, and topical and systemic retinoids.

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Corticosteroids

Class Summary

These agents are used to treat painful, erythematous, or erosive oral lichen planus lesions.

Betamethasone (Celestone, Soluspan)

 

Betamethasone decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. It affects the production of lymphokines and has an inhibitory effect on the Langerhans cells.

Fluocinolone (Synalar, Synalar-HP, Fluonid)

 

Fluocinolone is of medium potency. Use 0.01% or 0.025% cream, gel, or ointment with or without Orabase. It inhibits cell proliferation and is immunosuppressive, antiproliferative, and anti-inflammatory.

Clobetasol (Cormax, Olux, Temovate)

 

Clobetasol is of high potency. Use 0.05% ointment, gel, or cream with or without Orabase. It is a class I superpotent topical steroid. It suppresses mitosis and increases the synthesis of proteins that decrease inflammation and cause vasoconstriction. Ointment is recommended for intraoral use. Most pharmacists mix 15 g of clobetasol with 15 g of Orabase; this mixture should be indicated on the prescription.

Beclomethasone (Beclovent, Vanceril)

 

Beclomethasone is a corticosteroid inhalant typically used to treat asthma. Use a metered dose inhaler with 50 mcg per puff. Direct inhaler to sites of greatest erythema or erosion.

Triamcinolone (Amcort, Aristocort, Aristospan)

 

Triamcinolone is of medium potency. Use 0.1% triamcinolone acetonide in 1% carboxy cellulose for dental paste. Alternately, use 0.1% cream in Orabase or alone as a cream, ointment, or suspension for intralesional administration.

Prednisolone (Delta-Cortef, Prednisol TBA injection)

 

Prednisolone is for systemic therapy. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and by reducing capillary permeability.

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Immunosuppressants

Class Summary

These agents are used for painful, erythematous, or erosive oral lichen planus that is recalcitrant to topical corticosteroids.

Azathioprine (Imuran)

 

Azathioprine antagonizes purine metabolism. It inhibits the synthesis of DNA, RNA, and proteins. Azathioprine may decrease the proliferation of immune cells, resulting in lower autoimmune activity.

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Contributor Information and Disclosures
Author

Philip B Sugerman, MDS, PhD Senior Clinical Science Manager, Abbott Immunology, Abbott Laboratories

Philip B Sugerman, MDS, PhD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, International Association for Dental Research

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen R Porter, MD, PhD FDS RCS, FDS RSE, Professor of Oral Medicine, University College London; Academic Head, Director of Research Strategy, Oral Medicine/Special Needs Unit, Division of Maxillofacial Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute for Oral Health Sciences

Stephen R Porter, MD, PhD is a member of the following medical societies: British Association of Oral and Maxillofacial Surgeons, Royal College of Surgeons of England, Royal Society of Medicine, Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Gregory J Raugi, MD, PhD Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Plaquelike oral lichen planus on the buccal mucosa on the left side.
Reticular oral lichen planus on the buccal mucosa on the left side.
Ulcerative oral lichen planus on the dorsum of the tongue.
 
 
 
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