This handout is for lichen planus (dermatology lens). Your care team identified this based on: pruritic violaceous polygonal flat-topped papules with wickham striae, koebner phenomenon, on wrists / ankles / shins (classic cutaneous lp) (cribier ebm analysis pmid 9875189).
Other reasons your team may use this plan: reticular white striae or painful erosive/atrophic oral mucosal disease — erosive olp is painful, premalignant, and needs surveillance (cochrane olp corticosteroids pmid 32108333; gonzález-moles olp mt pmid 31422203); erosive vulvar/vaginal or penile disease ± gingival involvement (vulvovaginal-gingival syndrome) — scarring + dyspareunia risk (bashh 2024 vulval guideline pmid 39837649; jacques review pmid 33111963); perifollicular erythema/scale with scarring frontotemporal hairline recession (lichen planopilaris/ffa) or nail thinning/longitudinal ridging/pterygium — irreversible scarring, treat early (samrao ffa/hcq pmid 20698851; kępińska ffa guide pmid 35767748).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| clobetasol propionate | 0.05% ointment | topical | BID until flattened then taper | EBM analysis (Cribier PMID 9875189) — high-potency topical corticosteroid is the practical first-line for limited cutaneous LP; potency matched to thickness/site. |
| tacrolimus | 0.1% ointment | topical | BID | Cochrane OLP (Lodi PMID 32108333) + Guo meta-analysis (PMID 26960301) — topical calcineurin inhibitor as a steroid-sparing alternative for sensitive sites and steroid-atrophy risk. |
| triamcinolone acetonide | 5–10 mg/mL intralesional | intralesional | q3–4 wk | EBM analysis (Cribier PMID 9875189) — intralesional triamcinolone for thick hypertrophic plaques and nail-matrix disease unresponsive to topical therapy. |
| hydroxyzine | 25 mg PO at night | PO | nocte PRN | Adjunctive only — a sedating antihistamine for sleep-disrupting LP pruritus; not disease-modifying (Cribier PMID 9875189). |
Plan: Lichen planus — variant-stratified stepwise ladder (cutaneous / oral-erosive / genital / scarring LPP-FFA)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Chronic-disease maintenance: lifelong oral/genital erosive-LP malignant-transformation surveillance with tobacco/alcohol-cessation counselling and dental/irritant control, scarring-variant (LPP/FFA/nail) early-treatment + activity surveillance to prevent irreversible loss, HCV-status follow-through with hepatology, drug-reconciliation review for any recurrent lichenoid eruption (elderly polypharmacy), proactive topical maintenance for relapse-prone erosive sites, and step-down/step-up criteria. Dermatology continuity for any systemic agent; reassess the lichenoid differential if the course remains atypical.
Guideline: Cribier EBM analysis of LP therapy (Arch Dermatol 1998; PMID 9875189: acitretin first-line cutaneous, topical steroid first-line mucosal erosive) + Cochrane corticosteroids for OLP (Lodi et al, 2020; PMID 32108333: topical-steroid pain-resolution RR 1.91) + topical tacrolimus erosive OLP meta-analysis (Guo et al, 2015; PMID 26960301) + oral acitretin+TAC RCT for OLP (Vinay et al, JAMA Dermatol 2024; PMID 38055232: ODSS-75 88% vs 47%) + BASHH 2024 vulval conditions guideline (Edwards et al; PMID 39837649) + genital LP review (Jacques et al, 2020; PMID 33111963) + OLP malignant-transformation meta-analyses (González-Moles 2019 PMID 31422203; Iocca OPMD 2019 PMID 31803979; Offen 2022 PMID 35338329; Li 2023 PMID 37174004) + HCV–LP meta-analyses (Shengyuan 2009 PMID 19770446; Alaizari 2016 PMID 26475515) + lichen planopilaris/FFA treatment (Samrao 2010 PMID 20698851; Kępińska 2021 PMID 35767748; Ezzat/Miteva FFA II 2025 PMID 39800209)