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Medication

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

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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)