Clinical Commander

Back to dossier
derm.lichen-planus.core.v1PRODUCTION
derm.lichen-planus.core.v1

Lichen planus (dermatology lens)

dermatologysubacutechronicadult
Hard-required inputs
0 / 10
Care setting:

Encounter flow

12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Frame as a CHRONIC T-cell-mediated lichenoid mucocutaneous disease whose management is VARIANT-STRATIFIED: classic cutaneous is often self-limited (symptom control) whereas oral/genital erosive is premalignant (surveillance) and lichen planopilaris/FFA + nail are scarring (irreversible — treat early). Lichenoid drug eruption is the key mimic recognised here and routed by engine_id. HCV has a reciprocal association and is screened.

Inputs
0
Actions
0
Advance rule
Set
Advance when

variant-stratified framing set; premalignant + scarring + lichenoid-drug-eruption + HCV escape routes noted

Patient inputs (16)

Drug timeline (ACE-inhibitor, thiazide, antimalarial, beta-blocker, NSAID, anti-TNF, checkpoint inhibitor) + photodistribution distinguishes lichenoid drug eruption from idiopathic LP and decides withdrawal (Cribier PMID 9875189)

Wickham striae (clinical + dermoscopy) is the pivotal LP sign separating it from psoriasis/eczema/lichenoid mimics and targets the biopsy site (Cribier PMID 9875189)

Tobacco (OR 4.62) and alcohol (OR 3.22) independently raise OLP malignant-transformation risk — cessation is a disease-modifying non-pharm action (Offen OLP MT PMID 35338329; González-Moles PMID 31422203)

LP–HCV reciprocal association (OLP HCV OR 5.4–6.07) — screen where prevalent; HCV also raises OLP malignant-transformation risk (RR 4.46) and routes to hepatology (Shengyuan PMID 19770446; Alaizari PMID 26475515)

Adult-predominant disease; elderly polypharmacy raises the lichenoid-drug-eruption prior (drug reconciliation); pediatric LP is uncommon and widens the lichen-striatus differential (Cribier PMID 9875189)

Variant (classic cutaneous vs oral reticular/erosive vs genital vs nail vs lichen planopilaris/FFA vs hypertrophic vs bullous) is the single determinant of prognosis, surveillance need, and the regimen axis selected (Cribier EBM analysis PMID 9875189; BASHH 2024 PMID 39837649)

Cutaneous pruritus vs oral/genital erosive PAIN is the primary patient-reported outcome that drives step-up and analgesia decisions (Cochrane OLP PMID 32108333)

Lichen planopilaris/FFA and nail pterygium cause IRREVERSIBLE scarring — perifollicular erythema/scale, hairline progression, or nail pterygium mandates urgent aggressive therapy to halt before permanent loss (Samrao FFA/HCQ PMID 20698851; Ezzat/Miteva FFA II PMID 39800209)

Any non-healing, indurated, ulcerated, or leukoplakic change within OLP → biopsy for squamous cell carcinoma (premalignant disease; urgent) (González-Moles PMID 31422203; Iocca OPMD PMID 31803979)

Atrophic/erosive (red) oral or genital morphology is the highest-risk subtype for malignant transformation and mandates surveillance + biopsy of any non-healing area (González-Moles OLP MT erosive RR 4.09 PMID 31422203; Li 2023 PMID 37174004)

Anti-HCV screen given the LP–HCV reciprocal association, especially in oral/erosive disease and high-prevalence regions (Shengyuan PMID 19770446; Alaizari PMID 26475515)

Baseline + on-treatment monitoring for methotrexate myelosuppression / azathioprine-pathway agents before a systemic step (Vinay acitretin RCT PMID 38055232)

Acitretin transaminase/triglyceride monitoring, methotrexate hepatotoxicity, and HCV-related hepatic context (relevant to the HCV association) (Vinay PMID 38055232; Shengyuan PMID 19770446)

Acitretin (teratogen, 3-yr conception ban), methotrexate and mycophenolate are contraindicated in pregnancy; topical-first care is preferred — gates the systemic ladder (Cribier PMID 9875189)

Methotrexate renal dose-adjust + general systemic-agent safety; CKD-EPI 2021 race-free eGFR (Inker NEJM 2021)

Hydroxychloroquine (lichen planopilaris/FFA mainstay) requires baseline + periodic ophthalmologic retinopathy screening and weight-based dosing (Samrao FFA/HCQ PMID 20698851; Ezzat/Miteva FFA II PMID 39800209)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (7)

7 need judgement
  • informationalsevereoral_lp_scc_suspect_lesion
    Non-healing, indurated, ulcerated, or leukoplakic/erythroplakic change within oral (or genital) lichen planus, especially on the tongue or in atrophic-erosive disease
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereprogressive_scarring_lpp_ffa_or_nail_pterygium
    Active perifollicular erythema/scale with progressive frontotemporal hairline recession (lichen planopilaris/FFA) OR nail pterygium / 20-nail dystrophy
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveresevere_erosive_lp_functional_impairment
    Severe erosive oral or genital LP impairing oral intake, speech, sexual function, or causing intractable pain
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatewidespread_or_refractory_cutaneous_lp
    Widespread, rapidly progressive, or topical-refractory cutaneous (incl. hypertrophic) lichen planus
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatelichenoid_drug_eruption_suspected
    New/changed drug 2 wk–12 mo before a widespread, often photodistributed lichenoid eruption (ACE-inhibitor, thiazide, antimalarial, beta-blocker, NSAID, anti-TNF, checkpoint inhibitor)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatehcv_positive_lichen_planus
    Hepatitis C–positive (or high pre-test risk) patient with lichen planus, particularly oral/erosive disease
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatepregnancy_systemic_gating
    Pregnant/conceiving patient with LP requiring systemic therapy
    Trigger could not be auto-evaluated — needs clinician judgement.

Workflow calculators

Run this disease's risk and dosing calculators inline.

RISK_STRATIFICATIONoptionalDrives dose adjustment
Loading…

Recommended regimen

Lichen planus — variant-stratified stepwise ladder (cutaneous / oral-erosive / genital / scarring LPP-FFA)
axis: lp_variant_stratified_ladderstep 1 - Step 1 — Cutaneous limited LP (often self-limited; symptom control)
Selected step "Step 1 — Cutaneous limited LP (often self-limited; symptom control)" — Localised classic cutaneous / hypertrophic LP without extensive BSA or scarring/erosive variant
  • clobetasol propionate
    first line
    high_potency_topical_corticosteroid
    0.05% ointment • topical • BID until flattened then taper (max: limited duration/BSA; avoid face/folds)
    triggers: localised_cutaneous_or_hypertrophic_lp
    EBM analysis (Cribier PMID 9875189) — high-potency topical corticosteroid is the practical first-line for limited cutaneous LP; potency matched to thickness/site.
    rxcui 21245
  • tacrolimus
    second line
    topical_calcineurin_inhibitor
    0.1% ointment • topical • BID (max: per labeling)
    triggers: steroid_sparing, face_or_fold_or_atrophy_risk, steroid_inadequate
    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.
    rxcui 42316
  • triamcinolone acetonide
    second line
    intralesional_corticosteroid
    5–10 mg/mL intralesional • intralesional • q3–4 wk (max: per lesion volume)
    triggers: hypertrophic_recalcitrant_plaque, nail_matrix_disease
    EBM analysis (Cribier PMID 9875189) — intralesional triamcinolone for thick hypertrophic plaques and nail-matrix disease unresponsive to topical therapy.
    rxcui 10759
  • hydroxyzine
    add on
    first_gen_antihistamine
    25 mg PO at night • PO • nocte PRN (max: 100 mg/day)
    triggers: sleep_disrupting_pruritus
    Adjunctive only — a sedating antihistamine for sleep-disrupting LP pruritus; not disease-modifying (Cribier PMID 9875189).
    rxcui 5553

outpatient playbook — drug actions (4)

  1. 1. clobetasol propionate 0.05% (cutaneous limited; ultrapotent for genital)
    rxcui 21245
    0.05% ointment/gel • topical • BID then taper
    trigger: Localised cutaneous or erosive genital LP (Cochrane OLP PMID 32108333; BASHH 2024 PMID 39837649)
    High/ultrapotent topical corticosteroid first-line; topical-steroid pain-resolution RR 1.91 vs placebo
  2. 2. dexamethasone rinse / fluocinonide gel / topical tacrolimus (oral erosive)
    rxcui 3264
    0.5 mg/5 mL rinse • topical (oral) • QID swish-and-spit
    trigger: Erosive oral LP; tacrolimus if steroid-refractory or steroid-sparing (Cochrane OLP PMID 32108333; Guo PMID 26960301)
    Topical-first for premalignant erosive oral disease; tacrolimus non-inferior to steroid
  3. 3. acitretin (+ topical triamcinolone) for extensive/refractory cutaneous or refractory erosive
    rxcui 16818
    25–35 mg/day • PO • once daily
    trigger: Extensive/refractory cutaneous or refractory erosive oral LP, non-pregnant (Vinay PMID 38055232; Cribier PMID 9875189)
    Acitretin+TAC ODSS-75 88% vs 47%; first-line systemic for cutaneous LP; teratogen
  4. 4. hydroxychloroquine + topical/intralesional steroid ± 5α-reductase inhibitor (LPP/FFA)
    rxcui 5521
    ≤5 mg/kg/day • PO • BID
    trigger: Active lichen planopilaris/FFA — halt scarring early (Samrao PMID 20698851; Kępińska PMID 35767748)
    HCQ significant LPPAI reduction at 6 & 12 mo; finasteride highest evidence for FFA hairline; irreversible if untreated

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Pruritic violaceous polygonal flat-topped papules with Wickham striae, Koebner phenomenon, on wrists / ankles / shins (classic cutaneous LP) (Cribier EBM analysis PMID 9875189); 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).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Lichen planus (dermatology lens)** (derm.lichen-planus.core.v1).
Phenotype framing: Terminal lichenoid differential with named pivots: lichen planus (Wickham striae + violaceous polygonal papules + band-like lymphocytic interface biopsy pivot) vs lichenoid drug eruption (drug timeline + photodistribution + eosinophils/parakeratosis on biopsy pivot — route derm.drug-eruption.core.v1) vs psoriasis (sharp salmon plaque + silver scale + Auspitz + nail pits pivot — route derm.psoriasis.core.v1) vs discoid/cutaneous lupus (photodistribution + ANA + DIF lupus band + follicular plugging pivot — route rheum.sle.core.v1) vs lichen simplex chronicus (lichenified solitary pruritus plaque pivot) vs lichenoid GVHD (allogeneic-transplant context pivot) vs secondary syphilis (palmoplantar + mucous patches + RPR/TPPA pivot) vs oral leukoplakia / candidiasis / pemphigus / mucous-membrane pemphigoid (oral erosive — biopsy + DIF pivot) vs lichen sclerosus (genital white atrophic plaque pivot) vs pityriasis rosea (herald patch + Christmas-tree pivot).
Scope: Frame as a CHRONIC T-cell-mediated lichenoid mucocutaneous disease whose management is VARIANT-STRATIFIED: classic cutaneous is often self-limited (symptom control) whereas oral/genital erosive is premalignant (surveillance) and lichen planopilaris/FFA + nail are scarring (irreversible — treat early). Lichenoid drug eruption is the key mimic recognised here and routed by engine_id. HCV has a reciprocal association and is screened.

No severity triggers fired against current inputs.

Plan

Regimen axis: **Lichen planus — variant-stratified stepwise ladder (cutaneous / oral-erosive / genital / scarring LPP-FFA)** — step "Step 1 — Cutaneous limited LP (often self-limited; symptom control)".
1. clobetasol propionate 0.05% ointment topical BID until flattened then taper (high_potency_topical_corticosteroid, first line) — EBM analysis (Cribier PMID 9875189) — high-potency topical corticosteroid is the practical first-line for limited cutaneous LP; potency matched to thickness/site.
2. tacrolimus 0.1% ointment topical BID (topical_calcineurin_inhibitor, second line) — 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.
3. triamcinolone acetonide 5–10 mg/mL intralesional intralesional q3–4 wk (intralesional_corticosteroid, second line) — EBM analysis (Cribier PMID 9875189) — intralesional triamcinolone for thick hypertrophic plaques and nail-matrix disease unresponsive to topical therapy.
4. hydroxyzine 25 mg PO at night PO nocte PRN (first_gen_antihistamine, add on) — Adjunctive only — a sedating antihistamine for sleep-disrupting LP pruritus; not disease-modifying (Cribier PMID 9875189).

Setting playbook (outpatient) — Confirm clinico-pathologic LP and its variant (exclude lichenoid drug eruption + the erosive-oral DIF differential), stratify premalignant vs scarring vs self-limited, run the variant-stratified ladder, embed lifelong oral/genital surveillance + scarring-variant early treatment + HCV screening, and gate systemic agents on pregnancy / HCQ-retinopathy / steroid-taper (Cribier PMID 9875189; Cochrane OLP PMID 32108333; BASHH 2024 PMID 39837649)
5. clobetasol propionate 0.05% (cutaneous limited; ultrapotent for genital) 0.05% ointment/gel topical BID then taper — Localised cutaneous or erosive genital LP (Cochrane OLP PMID 32108333; BASHH 2024 PMID 39837649) (High/ultrapotent topical corticosteroid first-line; topical-steroid pain-resolution RR 1.91 vs placebo)
6. dexamethasone rinse / fluocinonide gel / topical tacrolimus (oral erosive) 0.5 mg/5 mL rinse topical (oral) QID swish-and-spit — Erosive oral LP; tacrolimus if steroid-refractory or steroid-sparing (Cochrane OLP PMID 32108333; Guo PMID 26960301) (Topical-first for premalignant erosive oral disease; tacrolimus non-inferior to steroid)
7. acitretin (+ topical triamcinolone) for extensive/refractory cutaneous or refractory erosive 25–35 mg/day PO once daily — Extensive/refractory cutaneous or refractory erosive oral LP, non-pregnant (Vinay PMID 38055232; Cribier PMID 9875189) (Acitretin+TAC ODSS-75 88% vs 47%; first-line systemic for cutaneous LP; teratogen)
8. hydroxychloroquine + topical/intralesional steroid ± 5α-reductase inhibitor (LPP/FFA) ≤5 mg/kg/day PO BID — Active lichen planopilaris/FFA — halt scarring early (Samrao PMID 20698851; Kępińska PMID 35767748) (HCQ significant LPPAI reduction at 6 & 12 mo; finasteride highest evidence for FFA hairline; irreversible if untreated)

Non-pharmacologic actions:
- Lifelong oral/genital erosive-LP malignant-transformation surveillance with biopsy of any non-healing/indurated/leukoplakic change (González-Moles PMID 31422203; Iocca PMID 31803979)
- Tobacco + alcohol cessation counselling (disease-modifying for OLP MT risk) + dental/sharp-tooth/irritant control for oral disease (Offen PMID 35338329)
- HCV screening + hepatology referral if positive (reciprocal association; MT-risk modifier) (Shengyuan PMID 19770446; Alaizari PMID 26475515)
- Withdraw a suspected lichenoid-culprit drug + route derm.drug-eruption.core.v1 (Cribier PMID 9875189)
- Genital LP: ultrapotent-steroid maintenance + vaginal dilator + gynaecology/urology referral to limit scarring/dyspareunia (BASHH 2024 PMID 39837649; Jacques PMID 33111963)

AVOID / contraindication checks:
- Acitretin methotrexate mycophenolate contraindicated in pregnancy (Cribier PMID 9875189; Vinay PMID 38055232 — acitretin teratogen with 3 year post treatment conception ban; topical first care preferred in pregnancy)
- Hydroxychloroquine baseline and periodic retinopathy screening (Samrao PMID 20698851; Ezzat/Miteva FFA II PMID 39800209 — dose ≤5 mg/kg actual body weight/day; ophthalmology baseline + periodic)
- Systemic corticosteroid short course with taper only (Cribier PMID 9875189 — avoid chronic systemic steroid monotherapy; taper to limit rebound + cumulative harm)
- Biopsy any non healing indurated or leukoplakic oral lp lesion for scc (González Moles PMID 31422203; Iocca OPMD PMID 31803979 — premalignant; erosive RR 4.09, tongue RR 1.82)
- Scarring variants lpp ffa and nail pterygium are irreversible treat early (Samrao PMID 20698851; Ezzat/Miteva FFA II PMID 39800209 — therapeutic goal is halting activity, not regrowth)
- Lichenoid drug eruption is managed by culprit withdrawal not immunosuppression escalation (Cribier PMID 9875189 — route derm.drug eruption.core.v1)
- Avoid puva phototherapy in photodistributed or lichenoid drug pattern disease (Cribier PMID 9875189)

Monitoring

Regimen monitoring:
- cutaneous lesion or itch at 4-12wk; oral erosive ODSS/pain at 4-12wk per step (Cochrane OLP PMID 32108333)
- oral/genital erosive LP: lifelong periodic mucosal exam + biopsy of any non-healing/indurated/leukoplakic change for SCC (MT ~1% overall, ~0.2-0.5%/yr; erosive RR 4.09, tongue RR 1.82, HCV RR 4.46) (González-Moles PMID 31422203; Iocca PMID 31803979; Li 2023 PMID 37174004)
- scarring-variant (LPP/FFA): activity index + hairline photography q3-6mo to judge HALT of progression (irreversible — not regrowth) (Samrao PMID 20698851; Ezzat/Miteva FFA II PMID 39800209)
- hydroxychloroquine: baseline + periodic ophthalmology retinopathy screen; dose ≤5 mg/kg/day (Samrao PMID 20698851)
- acitretin: LFT + fasting triglycerides periodically; strict pregnancy avoidance (Vinay PMID 38055232; Cribier PMID 9875189)
- methotrexate: CBC + LFT periodic + folic acid co-prescribed; systemic-steroid course: glucose/BP/bone + taper (Cribier PMID 9875189)
- tobacco/alcohol cessation reinforcement + HCV status follow-through with hepatology (Offen PMID 35338329; Shengyuan PMID 19770446)

Setting (outpatient) monitoring:
- Reassess cutaneous/itch or oral ODSS/pain at 4-12 wk per step; scarring-variant activity + photography q3-6 mo (Cochrane OLP PMID 32108333; Samrao PMID 20698851)
- Lifelong SCC surveillance for erosive oral/genital LP; drug-class safety (HCQ ophthalmology; acitretin LFT/triglycerides; MTX CBC/LFT) on schedule (González-Moles PMID 31422203; Vinay PMID 38055232)

Follow-up plan: 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.
- Close-out criterion: surveillance + cessation + scarring-early-treatment + HCV follow-through + drug-reconciliation + education documented

Monitoring phase: Disease: cutaneous lesion/itch at 4–12 wk; oral erosive ODSS/pain at 4–12 wk per step; scarring-variant (LPP/FFA) activity index + hairline/photography q3–6 mo (irreversible — judge halt of progression, not regrowth). SURVEILLANCE: oral/genital erosive LP periodic mucosal exam with biopsy of any change for SCC (lifelong; transformation ~1% overall, ~0.2–0.5%/yr, higher with erosive/tongue/HCV/tobacco). Drug safety: hydroxychloroquine baseline + periodic ophthalmology; acitretin LFT/triglycerides + pregnancy avoidance; methotrexate CBC/LFT + folic acid; systemic-steroid taper + glucose/BP/bone. Reassess for lichenoid-drug-eruption if course atypical.

Disposition

Current setting: outpatient — Confirm clinico-pathologic LP and its variant (exclude lichenoid drug eruption + the erosive-oral DIF differential), stratify premalignant vs scarring vs self-limited, run the variant-stratified ladder, embed lifelong oral/genital surveillance + scarring-variant early treatment + HCV screening, and gate systemic agents on pregnancy / HCQ-retinopathy / steroid-taper (Cribier PMID 9875189; Cochrane OLP PMID 32108333; BASHH 2024 PMID 39837649)

Disposition criteria:
- Continue variant-stratified ladder + surveillance + derm follow-up if responding (Cribier PMID 9875189)
- Step up the ladder if an adequate trial fails after adherence/trigger optimisation (exclude lichenoid drug eruption / re-biopsy)
- No admission pathway — escalate via specialty referral (oral medicine/OMFS, hepatology, gynaecology/urology, scarring-alopecia clinic)

Escalation triggers (move to higher acuity):
- Non-healing / indurated / ulcerated / leukoplakic oral-LP lesion → expedite biopsy for squamous cell carcinoma (premalignant — urgent) (González-Moles PMID 31422203)
- Rapidly progressive lichen planopilaris/FFA or nail pterygium → aggressive systemic therapy + multidisciplinary scarring-alopecia clinic (irreversible) (Samrao PMID 20698851)
- Severe erosive LP impairing oral intake/function → short systemic-steroid course + oral-medicine/specialist co-management (Cribier PMID 9875189)
- Lichenoid drug eruption suspected → reconcile + withdraw culprit + route derm.drug-eruption.core.v1 (Cribier PMID 9875189)
- HCV-positive → hepatology referral (Shengyuan PMID 19770446)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [SEVERE] Non-healing, indurated, ulcerated, or leukoplakic/erythroplakic change within oral (or genital) lichen planus, especially on the tongue or in atrophic-erosive disease
- [SEVERE] Active perifollicular erythema/scale with progressive frontotemporal hairline recession (lichen planopilaris/FFA) OR nail pterygium / 20-nail dystrophy
- [SEVERE] Severe erosive oral or genital LP impairing oral intake, speech, sexual function, or causing intractable pain

Citations

- 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) [PMID:9875189](https://pubmed.ncbi.nlm.nih.gov/9875189/)
- Cited evidence (PMID 32108333) [PMID:32108333](https://pubmed.ncbi.nlm.nih.gov/32108333/)
- Cited evidence (PMID 26960301) [PMID:26960301](https://pubmed.ncbi.nlm.nih.gov/26960301/)
- Cited evidence (PMID 38055232) [PMID:38055232](https://pubmed.ncbi.nlm.nih.gov/38055232/)
- Cited evidence (PMID 39837649) [PMID:39837649](https://pubmed.ncbi.nlm.nih.gov/39837649/)

Last reconciled with current guidelines: 2026-05-22.
References
  • 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) — PMID:9875189
  • Cited evidence (PMID 32108333) — PMID:32108333
  • Cited evidence (PMID 26960301) — PMID:26960301
  • Cited evidence (PMID 38055232) — PMID:38055232
  • Cited evidence (PMID 39837649) — PMID:39837649