What is your treatment algorithm for patients with lichen planus?
What treatment for lichen planus have you found to be the most effective at producing long-term improvement?
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There are many potential approaches depending on the severity, subtype, comorbidities, and impact on QOL. For "classic" LP (no symptomatic or significant oral involvement)"
Typically itch is the primary complaint although the appearance can be understandably upsetting to some patients.
Depending on the patient, hepatitis screening may be needed.
If the patient wishes to treat, nbUVB can be quite effective for some patients, as can topical steroids or ILK.
One of my mentors will do IMK every 3 mo for 6-12 mo and feels this can hasten resolution with few side effects.
Methotrexate is a good first line systemic treatment. Some people find success with oral metronidazole; I have found this sometimes helpful (less so than others) so use it more ...
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For cost and safety profile, I have been starting a couple of months of metronidazole concurrently with hydroxychloroquine. I have seen metronidazole (on a couple of occasions) turn off oral LP, but will skip this step if they are hesitant to avoid EtOH. If not significantly improved in 3 months, will consider MTX. Any significantly itchy patient gets IMK at the first visit to help buy us time for something to start working.
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