Oral Lichen Planus Medication

  • Author: Philip B Sugerman, MDS, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Oct 29, 2010
 

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. 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.

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Betamethasone (Celestone, Soluspan)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Affects the production of lymphokines and has an inhibitory effect on the Langerhans cells.

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Fluocinolone (Synalar, Synalar-HP, Fluonid)

 

Medium potency. Use 0.01% or 0.025% cream, gel, or ointment with or without Orabase. Inhibits cell proliferation, is immunosuppressive, antiproliferative, and anti-inflammatory.

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Clobetasol (Cormax, Olux, Temovate)

 

High potency. Use 0.05% ointment, gel, or cream with or without Orabase. Class I superpotent topical steroid. Suppresses mitosis and increases 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.

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Beclomethasone (Beclovent, Vanceril)

 

Corticosteroid inhalant typically used to treat asthma. Use MDI with 50 mcg per puff. Direct inhaler to sites of greatest erythema or erosion.

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Triamcinolone (Amcort, Aristocort, Aristospan)

 

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.

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Prednisolone (Delta-Cortef, Prednisol TBA injection)

 

Systemic therapy. Decreases inflammation by suppressing 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.

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Azathioprine (Imuran)

 

Antagonizes purine metabolism. Inhibits synthesis of DNA, RNA, and proteins. May decrease 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 and International Association for Dental Research

Disclosure: Abbott Labs Salary Employment

Coauthor(s)

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory J Raugi, MD, PhD  Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; 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.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

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

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD 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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