Lichen planus - Treating lichen planus

There's no cure for lichen planus, so treatments aim to ease the symptoms and clear the rash. Mild lichen planus doesn't require treatment.

Self-help

Below is some general self-help advice that can help ease your symptoms and prevent them getting worse.

Lichen planus of the skin

• avoid washing with soap or bubble bath – use plain warm water instead
• wash your hair over a basin to stop affected areas of skin coming into contact with shampoo
• use an emollient to moisturise your skin 

Lichen planus of the mouth (oral lichen planus)

• avoid eating spicy foods and anything acidic, such as fruit juice, because they can irritate oral lichen planus
• avoid eating sharp food, such as crusty bread
• avoid drinking alcohol, particularly spirits
• if areas of your mouth are painful, stick to soft, bland foods, such as mashed potatoes and porridge
• if possible, continue to use your usual toothpaste
• avoid using mouthwashes that contain alcohol because they may be too strong, and keep your mouth as clean as possible
• visit your dentist regularly to help keep your teeth and gums healthy

Lichen planus of the genitals

• avoid washing with soap or bubble bath – use plain warm water or a soap substitute instead, such as aqueous cream
• use an emollient, such as petroleum jelly, before and after urinating
• applying ice packs to the affected areas may soothe itching and swelling (never apply an ice pack directly to your skin – wrap it in a clean tea towel before placing it on your body)
• women should avoid wearing tights

Lichen planus of the skin, hair and nails

There are a number of medications and treatments that may be recommended for lichen planus of the skin, hair and nails. These are outlined below.  

Corticosteroid creams and ointments

Corticosteroid creams and ointments contain corticosteroids (artificial hormones) and are used to treat inflammatory skin conditions. They are often referred to as topical corticosteroids.

Topical corticosteroids help treat the swelling (inflammation) and redness caused by lichen planus. Strong topical corticosteroids, such as clobetasol propionate, are also effective in reducing any itchiness you may have.

Treatment is applied to the red or purple itchy spots, but should be stopped when the colour of the rash changes to brown or grey. This pigment change occurs when the inflammation has settled. Continuing to apply the corticosteroid cream to the brown areas of skin will gradually cause the skin to thin.

The side effects of corticosteroids can vary, depending on the:

• type and severity of treatment being used
• how long the treatment is used for
• nature of the condition being treated

Potential side effects of topical corticosteroids can include:

• redness or burning and stinging of the skin
• skin rash
• thinning of the skin (atrophy)
• stretch marks (striae) 
• contact dermatitis – a condition that causes skin inflammation
• excessive hair growth (hypertrichosis)
• lightening of the skin

Always check the patient information leaflet that comes with your medicine.

Corticosteroid tablets

Corticosteroid tablets are sometimes used to treat severe cases of lichen planus, when the symptoms aren't being effectively controlled with creams or ointments.

Possible side effects of corticosteroid tablets used on a short-term basis can include:

• increased appetite
• weight gain
• insomnia
• fluid retention (inability to pass urine)
• mood changes, such as feeling irritable or anxious

Read more about the side effects of corticosteroids.

Other treatments

Other treatments recommended for lichen planus of the skin are outlined below. 

• Antihistamines – these are often used to treat symptoms of allergies, such as itchy skin. If you have lichen planus of the skin that's causing itchiness, antihistamines may be prescribed to help reduce this.
• Light treatment – there are two types of light treatment: ultraviolet B (UVB) and psoralen plus ultraviolet A (PUVA). UVB is the most commonly used light treatment, but PUVA may be recommended in severe or widespread cases of lichen planus that don't respond to other types of treatment. 
• Acitretin – this medication is only prescribed by a specialist and is used to treat severe cases of lichen planus. The tablets have some associated side effects and may not mix well with other medicines. Your specialist can offer advice.

Lichen planus of the mouth (oral lichen planus)

Mild cases of oral lichen planus won't need any treatment. In more severe cases, treatment includes:

• a mouthwash that contains an anaesthetic to temporarily numb the mouth, which makes eating easier
• corticosteroid sprays, mouthwashes, pastes and dissolvable lozenges
• a mouthwash or gel that contains an antiseptic to help prevent the build-up of plaque in your mouth

In more severe cases of oral lichen planus, corticosteroid tablets (see above) may also be used on a short-term basis.

It can be difficult to prevent oral lichen planus, but to keep the lining of your mouth healthy it's recommended that you:

• stop smoking (if you smoke)
• avoid drinking large amounts of alcohol
• have a healthy, balanced diet, including plenty of fresh fruit and vegetables

You should also maintain good oral hygiene by cleaning your teeth at least twice a day, and having regular dental check-ups, so that any problems with your teeth or mouth can be identified and treated early.

Other treatments

If corticosteroids are not effective in treating your symptoms, you may be prescribed a medication that suppresses your immune system to try to limit the autoimmune reaction that's thought to cause lichen planus.

These types of treatments are known as immunomodulating agents. Depending on which area of your body is affected by lichen planus, treatments that may be recommended for you can include: treatments such as tacrolimus 

• topical immunomodulating agents (used to treat lichen planus of the skin) – treatments such as tacrolimus ointment and pimecrolimus cream are rubbed directly onto the skin
• immunomodulating agents (used to treat lichen planus of the mouth) – these are usually available in the form of tablets or capsules, and can be used to treat severe cases of oral lichen planus

These treatments can cause a number of different side effects, which your specialist can discuss with you.

You'll also need to have regular blood tests while taking immunomodulating agents, particularly in the early stages of treatment.