Medication Summary

Topical corticosteroids are the mainstay of medical treatment of oral lichen planus (OLP), although rarely, corticosteroids may be administered intralesionally for a focal lesion or systemically for diffuse recalcitrant lesions. 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.^{[58, 59]}Other potential therapies for recalcitrant oral lichen planus include cyclosporin,^[60]hydroxychloroquine,^[61]azathioprine,^[62]dexamethasone elixir, mycophenolate,^[63]dapsone,^[59]systemic corticosteroids, and topical and systemic retinoids.^[60]Oral lichen planus has been treated successfully with thalidomide,^{[15, 16]}but this is considered experimental and associated with significant potential adverse effects; only clinicians trained thoroughly by the manufacturer can prescribe this agent.

Close monitoring of patients is essential when these medications are prescribed. Only practitioners completely familiar with the use of immunosuppressive drugs should attempt such treatment.

Class Summary

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

Betamethasone (Celestone Soluspan, Betamethasone Combo)

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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, Xilapak)

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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 (Impoyz, Clobex, Olux, Temovate)

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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, inhaled (Qvar)

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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 (Oralone, Trianex, Triderm, Kenalog)

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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 (Millipred, Orapred, Veripred)

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

Class Summary

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

Azathioprine (Imuran, Azasan)

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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.

Questions

Sugerman PB, Satterwhite K, Bigby M. Autocytotoxic T-cell clones in lichen planus. Br J Dermatol. 2000 Mar. 142(3):449-56. [QxMD MEDLINE Link].
Sugerman PB, Savage NW, Walsh LJ, et al. The pathogenesis of oral lichen planus. Crit Rev Oral Biol Med. 2002. 13(4):350-65. [QxMD MEDLINE Link].
Shan J, Ma JM, Wang R, Liu QL, Fan Y. Proliferation and Apoptosis of Peripheral Blood Mononuclear Cells in Patients with Oral Lichen Planus. Inflammation. 2012 Nov 8. [QxMD MEDLINE Link].
Younes F, Quartey EL, Kiguwa S, Partridge M. Expression of TNF and the 55-kDa TNF receptor in epidermis, oral mucosa, lichen planus and squamous cell carcinoma. Oral Dis. 1996 Mar. 2(1):25-31. [QxMD MEDLINE Link].
Sklavounou A, Chrysomali E, Scorilas A, Karameris A. TNF-alpha expression and apoptosis-regulating proteins in oral lichen planus: a comparative immunohistochemical evaluation. J Oral Pathol Med. 2000 Sep. 29(8):370-5. [QxMD MEDLINE Link].
Khan A, Farah CS, Savage NW, Walsh LJ, Harbrow DJ, Sugerman PB. Th1 cytokines in oral lichen planus. J Oral Pathol Med. 2003 Feb. 32(2):77-83. [QxMD MEDLINE Link].
Thongprasom K, Dhanuthai K, Sarideechaigul W, Chaiyarit P, Chaimusig M. Expression of TNF-alpha in oral lichen planus treated with fluocinolone acetonide 0.1%. J Oral Pathol Med. 2006 Mar. 35(3):161-6. [QxMD MEDLINE Link].
Simon M Jr, Gruschwitz MS. In situ expression and serum levels of tumour necrosis factor alpha receptors in patients with lichen planus. Acta Derm Venereol. 1997 May. 77(3):191-3. [QxMD MEDLINE Link].
Simark-Mattsson C, Bergenholtz G, Jontell M, et al. Distribution of interleukin-2, -4, -10, tumour necrosis factor-alpha and transforming growth factor-beta mRNAs in oral lichen planus. Arch Oral Biol. 1999 Jun. 44(6):499-507. [QxMD MEDLINE Link].
Karagouni EE, Dotsika EN, Sklavounou A. Alteration in peripheral blood mononuclear cell function and serum cytokines in oral lichen planus. J Oral Pathol Med. 1994 Jan. 23(1):28-35. [QxMD MEDLINE Link].
Sugermann PB, Savage NW, Seymour GJ, Walsh LJ. Is there a role for tumor necrosis factor-alpha (TNF-alpha) in oral lichen planus?. J Oral Pathol Med. 1996 May. 25(5):219-24. [QxMD MEDLINE Link].
Sklavounou A, et al. Elevated serum levels of the apoptosis related molecules TNF-alpha, Fas/Apo-1 and Bcl-2 in oral lichen planus. J Oral Pathol Med. 2004. 33:386-390.
Rhodus NL, Cheng B, Myers S, Bowles W, Ho V, Ondrey F. A comparison of the pro-inflammatory, NF-kappaB-dependent cytokines: TNF-alpha, IL-1-alpha, IL-6, and IL-8 in different oral fluids from oral lichen planus patients. Clin Immunol. 2005 Mar. 114(3):278-83. [QxMD MEDLINE Link].
Carrozzo M, Uboldi de Capei M, Dametto E, et al. Tumor necrosis factor-alpha and interferon-gamma polymorphisms contribute to susceptibility to oral lichen planus. J Invest Dermatol. 2004 Jan. 122(1):87-94. [QxMD MEDLINE Link].
Dereure O, Basset-Seguin N, Guilhou JJ. Erosive lichen planus: dramatic response to thalidomide. Arch Dermatol. 1996 Nov. 132(11):1392-3. [QxMD MEDLINE Link].
Camisa C, Popovsky JL. Effective treatment of oral erosive lichen planus with thalidomide. Arch Dermatol. 2000 Dec. 136(12):1442-3. [QxMD MEDLINE Link].
Sampaio EP, Sarno EN, Galilly R, Cohn ZA, Kaplan G. Thalidomide selectively inhibits tumor necrosis factor alpha production by stimulated human monocytes. J Exp Med. 1991 Mar 1. 173(3):699-703. [QxMD MEDLINE Link].
Moreira AL, Sampaio EP, Zmuidzinas A, Frindt P, Smith KA, Kaplan G. Thalidomide exerts its inhibitory action on tumor necrosis factor alpha by enhancing mRNA degradation. J Exp Med. 1993 Jun 1. 177(6):1675-80. [QxMD MEDLINE Link].
Abdel-Haq A, Kusnierz-Cabala B, Darczuk D, Sobuta E, Dumnicka P, Wojas-Pelc A, et al. Interleukin-6 and neopterin levels in the serum and saliva of patients with Lichen planus and oral Lichen planus. J Oral Pathol Med. 2014 Nov. 43 (10):734-9. [QxMD MEDLINE Link].
Santarelli A, Mascitti M, Rubini C, Bambini F, Zizzi A, Offidani A, et al. Active inflammatory biomarkers in oral lichen planus. Int J Immunopathol Pharmacol. 2015 Dec. 28 (4):562-8. [QxMD MEDLINE Link].
Byun JS, Hong SH, Choi JK, Jung JK, Lee HJ. Diagnostic profiling of salivary exosomal microRNAs in oral lichen planus patients. Oral Dis. 2015 Nov. 21 (8):987-93. [QxMD MEDLINE Link].
Porter SR, Kirby A, Olsen I, Barrett W. Immunologic aspects of dermal and oral lichen planus: a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Mar. 83(3):358-66. [QxMD MEDLINE Link].
Scully C, Beyli M, Ferreiro MC, et al. Update on oral lichen planus: etiopathogenesis and management. Crit Rev Oral Biol Med. 1998. 9(1):86-122. [QxMD MEDLINE Link].
Sugerman PB, Savage NW, Zhou X, Walsh LJ, Bigby M. Oral lichen planus. Clin Dermatol. 2000 Sep-Oct. 18(5):533-9. [QxMD MEDLINE Link].
Sahebjamiee M, Sand L, Karimi S, Biettolahi JM, Jabalameli F, Jalouli J. Prevalence of human papillomavirus in oral lichen planus in an Iranian cohort. J Oral Maxillofac Pathol. 2015 May-Aug. 19 (2):170-4. [QxMD MEDLINE Link].
Mattila R, Rautava J, Syrjänen S. Human papillomavirus in oral atrophic lichen planus lesions. Oral Oncol. 2012 Oct. 48 (10):980-4. [QxMD MEDLINE Link].
Lodi G, Porter SR, Scully C. Hepatitis C virus infection: Review and implications for the dentist. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jul. 86(1):8-22. [QxMD MEDLINE Link].
Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K. Current controversies in oral lichen planus: report of an international consensus meeting. Part 1. Viral infections and etiopathogenesis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Jul. 100(1):40-51. [QxMD MEDLINE Link].
Karthikeyan P, Aswath N. Stress as an etiologic co-factor in recurrent aphthous ulcers and oral lichen planus. J Oral Sci. 2016. 58 (2):237-40. [QxMD MEDLINE Link].
Tvarijonaviciute A, Aznar-Cayuela C, Rubio CP, Ceron JJ, López-Jornet P. Evaluation of salivary oxidate stress biomarkers, nitric oxide and C-reactive protein in patients with oral lichen planus and burning mouth syndrome. J Oral Pathol Med. 2017 May. 46 (5):387-392. [QxMD MEDLINE Link].
Payeras MR, Cherubini K, Figueiredo MA, Salum FG. Oral lichen planus: focus on etiopathogenesis. Arch Oral Biol. 2013 Sep. 58 (9):1057-69. [QxMD MEDLINE Link].
Krupaa RJ, Sankari SL, Masthan KM, Rajesh E. Oral lichen planus: An overview. J Pharm Bioallied Sci. 2015 Apr. 7 (Suppl 1):S158-61. [QxMD MEDLINE Link].
Axéll T, Rundquist L. Oral lichen planus--a demographic study. Community Dent Oral Epidemiol. 1987 Feb. 15(1):52-6. [QxMD MEDLINE Link].
De Rossi SS, Ciarrocca K. Oral lichen planus and lichenoid mucositis. Dent Clin North Am. 2014 Apr. 58 (2):299-313. [QxMD MEDLINE Link].
Lopez-Jornet P, Camacho-Alonso F. Quality of life in patients with oral lichen planus. J Eval Clin Pract. 2010 Feb. 16(1):111-3. [QxMD MEDLINE Link].
Fitzpatrick SG, Hirsch SA, Gordon SC. The malignant transformation of oral lichen planus and oral lichenoid lesions: a systematic review. J Am Dent Assoc. 2014 Jan. 145 (1):45-56. [QxMD MEDLINE Link].
Burkhart NW, Burkes EJ, Burker EJ. Meeting the educational needs of patients with oral lichen planus. Gen Dent. 1997 Mar-Apr. 45(2):126-32; quiz 143-4. [QxMD MEDLINE Link].
Eisen D. The evaluation of cutaneous, genital, scalp, nail, esophageal, and ocular involvement in patients with oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Oct. 88(4):431-6. [QxMD MEDLINE Link].
Koch P, Bahmer FA. Oral lesions and symptoms related to metals used in dental restorations: a clinical, allergological, and histologic study. J Am Acad Dermatol. 1999 Sep. 41(3 Pt 1):422-30. [QxMD MEDLINE Link].
Ramer MA, Altchek A, Deligdisch L, Phelps R, Montazem A, Buonocore PM. Lichen planus and the vulvovaginal-gingival syndrome. J Periodontol. 2003 Sep. 74 (9):1385-93. [QxMD MEDLINE Link].
Pendyala G, Joshi S, Kalburge J, Joshi M, Tejnani A. Oral Lichen Planus: A Report and Review of an Autoimmune-Mediated Condition in Gingiva. Compend Contin Educ Dent. 2012 Sep. 33(8):e102-e108. [QxMD MEDLINE Link].
Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients. J Am Acad Dermatol. 2002 Feb. 46(2):207-14. [QxMD MEDLINE Link].
Eisenberg E. Oral lichen planus: a benign lesion. J Oral Maxillofac Surg. 2000 Nov. 58(11):1278-85. [QxMD MEDLINE Link].
Silverman S Jr. Oral lichen planus: a potentially premalignant lesion. J Oral Maxillofac Surg. 2000 Nov. 58(11):1286-8. [QxMD MEDLINE Link].
Németh CG, Röcken C, Siebert R, Wiltfang J, Ammerpohl O, Gassling V. Recurrent chromosomal and epigenetic alterations in oral squamous cell carcinoma and its putative premalignant condition oral lichen planus. PLoS One. 2019. 14 (4):e0215055. [QxMD MEDLINE Link].
Bardellini E, Amadori F, Flocchini P, Bonadeo S, Majorana A. Clinicopathological features and malignant transformation of oral lichen planus: A 12-years retrospective study. Acta Odontol Scand. 2012 Nov 2. [QxMD MEDLINE Link].
Gorsky M, Epstein JB. Oral lichen planus: malignant transformation and human papilloma virus: a review of potential clinical implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Apr. 111 (4):461-4. [QxMD MEDLINE Link].
Young SK, Min KW. In situ DNA hybridization analysis of oral papillomas, leukoplakias, and carcinomas for human papillomavirus. Oral Surg Oral Med Oral Pathol. 1991 Jun. 71 (6):726-9. [QxMD MEDLINE Link].
Baccaglini L, Thongprasom K, Carrozzo M, Bigby M. Urban legends series: lichen planus. Oral Dis. 2013 Mar. 19 (2):128-43. [QxMD MEDLINE Link].
Kumaraswamy KL, Vidhya M, Rao PK, Mukunda A. Oral biopsy: oral pathologist's perspective. J Cancer Res Ther. 2012 Apr-Jun. 8 (2):192-8. [QxMD MEDLINE Link].
Fernández-González F, Vázquez-Álvarez R, Reboiras-López D, Gándara-Vila P, García-García A, Gándara-Rey JM. Histopathological findings in oral lichen planus and their correlation with the clinical manifestations. Med Oral Patol Oral Cir Bucal. 2011 Aug 1. 16 (5):e641-6. [QxMD MEDLINE Link].
Chan ES, Thornhill M, Zakrzewska J. Interventions for treating oral lichen planus. Cochrane Database Syst Rev. 2000. CD001168. [QxMD MEDLINE Link].
Eisen D. The therapy of oral lichen planus. Crit Rev Oral Biol Med. 1993. 4(2):141-58. [QxMD MEDLINE Link].
McCartan B, McCreary C. What is the rationale for treating oral lichen planus?. Oral Dis. 1999 Jul. 5(3):181-2. [QxMD MEDLINE Link].
Fitzpatrick SG, Hirsch SA, Gordon SC. The malignant transformation of oral lichen planus and oral lichenoid lesions: a systematic review. J Am Dent Assoc. 2014 Jan. 145 (1):45-56. [QxMD MEDLINE Link].
Shavit E, Hagen K, Shear N. Oral lichen planus: a novel staging and algorithmic approach and all that is essential to know. F1000Res. 2020. 9:[QxMD MEDLINE Link].
Sandhu SV, Sandhu JS, Bansal H, Dua V. Oral lichen planus and stress: An appraisal. Contemp Clin Dent. 2014 Jul. 5(3):352-6. [QxMD MEDLINE Link].
Shilpa PS, Kaul R, Bhat S, Sanjay CJ, Sultana N. Topical tacrolimus in the management of oral lichen planus: literature review. J Calif Dent Assoc. 2014 Mar. 42(3):165-70. [QxMD MEDLINE Link].
Singh AR, Rai A, Aftab M, Jain S, Singh M. Efficacy of steroidal vs non-steroidal agents in oral lichen planus: a randomised, open-label study. J Laryngol Otol. 2017 Jan. 131 (1):69-76. [QxMD MEDLINE Link].
Di Stasio D, Guida A, Salerno C, Contaldo M, Esposito V, Laino L, et al. Oral lichen planus: a narrative review. Front Biosci (Elite Ed). 2014 Jun 1. 6:370-6. [QxMD MEDLINE Link].
Bendas ER, Abdullah H, El-Komy MH, Kassem MA. Hydroxychloroquine niosomes: a new trend in topical management of oral lichen planus. Int J Pharm. 2013 Dec 31. 458 (2):287-95. [QxMD MEDLINE Link].
Verma KK, Mittal R, Manchanda Y. Azathioprine for the treatment of severe erosive oral and generalized lichen planus. Acta Derm Venereol. 2001 Oct-Nov. 81 (5):378-9. [QxMD MEDLINE Link].
Dalmau J, Puig L, Roé E, Peramiquel L, Campos M, Alomar A. Successful treatment of oral erosive lichen planus with mycophenolate mofetil. J Eur Acad Dermatol Venereol. 2007 Feb. 21 (2):259-60. [QxMD MEDLINE Link].

Media Gallery

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.
Lichen planus nail involvement.

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Author

Jaisri R Thoppay, DDS, MBA, MS President, Center for Integrative Oral Health, Inc

Jaisri R Thoppay, DDS, MBA, MS is a member of the following medical societies: American Academy of Oral Medicine, American Academy of Orofacial Pain, American Association for Dental Research, American Dental Association, American Dental Education Association, International Association for Dental Research, Richmond Dental Society, Virginia Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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, Dermatology of Southwest Ohio

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

Jeff Burgess, DDS, MSD (Retired) Clinical Assistant Professor, Department of Oral Medicine, University of Washington School of Dental Medicine; (Retired) Attending in Pain Center, University of Washington Medical Center; (Retired) Private Practice in Hawaii and Washington; Director, Oral Care Research Associates

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.

Stephen R Porter, MD, PhD, FDSRCS(Eng), FDSRSE 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, UK

Stephen R Porter, MD, PhD, FDSRCS(Eng), FDSRSE 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, Royal Society of Medicine

Disclosure: Nothing to disclose.

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.

Oral Lichen Planus Medication

Medication Summary

Corticosteroids

Class Summary

Betamethasone (Celestone Soluspan, Betamethasone Combo)