RISK FACTORS Exposure to drugs or chemicals, graft versus host disease, or lupus erythematosus (LE-LP overlap syndrome)
GENERAL MEASURES
β’ Goal is to relieve itching with topical and systemic antipruritics
β’ Psoralens and ultraviolet A (PUVA) photochemotherapy may be helpful for generalized or resistant cases
β’ Behavior modification for stress reduction may prevent recurrence
DRUG(S) OF CHOICE
. Skin
. Topical steroids (e.g., 0.1% triamcinolone acetonide) with occlusion
. Intralesional corticosteroids, e.g., triamcinolone (Kenalog) 5-10 mg/mL, for hypertrophic lesions
. Antihistamine (e.g., hydroxyzine, dosage - 25 mg q6h) if needed for itching
. Mucous membranes
. Topical oral retinoids, e.g., 0.05% tretinoin (retinoic acid) in Orabase or topical oral corticosteroids (0.1%
triamcinolone (Kenalog in Orabase) bid
. Intralesional corticosteroids for erosive, painful lichen planus, e.g., 0.5-1.0 mL methylprednisolone (Depo-
Medrol) 40 mg/mL
. Oral retinoids - isotretinoin (Accutane) or etretinate (Tegison)
Precautions:
β’ Systemic absorption of steroids may result in hypothalamic-pituitary-adrenal axis suppression, Cushing
syndrome, hyperglycemia, and glucosuria
β’ Increased risk with high potency - i.e., use over large surface area, prolonged use, occlusive dressings
β’ These medications are Category C teratogens. Avoid in pregnancy.
β’ Children may absorb a proportionally larger amount of topical steroid due to larger skin surface to weight ratio
ALTERNATIVE DRUGS
β’ Oral prednisone - rarely used and only for a short course (e.g., prednisone 20 mg bid x 2-4 weeks)
β’ Cyclosporine may be used in severe cases, but cost and potential toxicity limits its use. Topical use for
severe oral involvement refractory to other treatments.
β’ Thalidomide
β’ PUVA or narrow band UVB
β’ Griseofulvin
β’ Azathioprine
β’ Mycophenolate mofetil
POSSIBLE COMPLICATIONS
β’ Alopecia
β’ Nail destruction
β’ Squamous cell carcinoma of the mouth
EXPECTED COURSE/PROGNOSIS
β’ Spontaneous resolution in weeks is possible, but disease may persist for years - especially in the mouth
and on shins
β’ There is a tendency toward relapse, especially with emotional stress
β’ Recurrence 12-20% especially in those with generalized involvement