Cutaneous Lichen Planus When Topical Steroids Have Not Worked
When first-line topical treatment does not adequately control cutaneous lichen planus, the clinical situation calls for a different approach. This protocol addresses that specific scenario.
When First-Line Treatment Has Failed
The initial approach to cutaneous lichen planus relies on topical glucocorticoids as the treatment of choice, with symptomatic adjuvants for pruritus. Escalation to this protocol is indicated when those measures have not achieved the goals of reduction of itching and resolution of the cutaneous lesions.
Next-Step Treatment Approach
When topical therapy proves insufficient, management shifts to systemic agents. More than one class of systemic treatment may be considered, and the appropriate choice depends on individual patient factors. The full options, selection criteria, and treatment sequence are set out in the complete protocol.
References
DOI: 10.1111/jdv.16464
- When topical glucocorticoids are ineffective, oral corticosteroids are administered.
- If lesions are unresponsive to topical treatment, oral prednisone of 30–80 mg/day for 4–6 weeks or intramuscular injections of triamcinolone 40–80 mg every 6–8 weeks are administered.
- Acitretin 20–35 mg/day, or isotretinoin.
- Oral cyclosporine (3–5 mg/kg/day).
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