Individualizing treatment and choice of medication in lichen planus: a step by step approach

Authors

  • Ioannis Manousaridis,

    1. Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
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  • Kleanthis Manousaridis,

    1. Department of Ophthalmology, LKH Feldkirch, Academic Hospital of the University of Innsbruck, Feldkirch, Austria
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  • Wiebke Katharina Peitsch,

    1. Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
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  • Stefan Werner Schneider

    Corresponding author
    • Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
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  • Conflict of interest None.

Correspondence to

Stefan Werner Schneider, MD, Prof.

Department of Dermatology, Venereology and Allergology

University Medical Centre Mannheim

University of Heidelberg

Theodor-Kutzer-Ufer 1-3

68135 Mannheim, Germany

E-mail: stefan.schneider@medma.uni-heidelberg.de

Summary

Although lichen planus is one of the most common dermatological entities, very few reviews on its management exist in the literature. Standard therapeutic approaches include various topical treatments (including topical corticosteroids, calcineurin inhibitors, vitamin D analogs) and phototherapy modalities, as well as systemic corticosteroids and systemic retinoids. While localized skin lesions are easily managed with standard modalities, generalized forms and in particular involvement of hair follicles, nails and mucosa, as well as eyes are often challenging. This review proposes an evidence-based and differential therapeutic regime, taking into account many new emerging systemic therapies to help clinicians optimize treatment according to the type, extent and severity of the disease. An individual therapeutic ladder has been developed for each location, starting with standard modalities and ranking alternative systemic treatments (mainly methotrexate and hydroxychloroquine, as well as cyclosporine, azathioprine and mycophenolate mofetil) according to efficacy, evidence level and side-effect profile.

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