What is the first-line treatment for lichen planus?

Topical corticosteroids are considered the first-line treatment for lichen planus due to their efficacy in reducing inflammation and relieving symptoms such as itching and discomfort. Lichen planus is an inflammatory condition that can affect the skin, mucous membranes, hair, and nails. Topical corticosteroids work by suppressing the immune response in the affected areas, which helps to alleviate the characteristic lesions and promote healing.

The potency of the corticosteroid may be adjusted based on the severity of the condition and the area of skin affected; more potent formulations can be used for thicker skin areas. Given their local application, topical corticosteroids also minimize systemic side effects, making them a preferred option in most cases.

Other treatment options, such as oral antihistamines, systemic steroids, and phototherapy, can be beneficial in certain circumstances or for more severe cases, but they are not considered the first line. Oral antihistamines may help with itching but do not address the underlying inflammation. Systemic steroids can be effective for widespread or severe disease but carry a higher risk of side effects and are typically reserved for refractory cases. Phototherapy may be useful in chronic forms not responsive to topical treatments, but it is generally not the initial approach. Thus, topical corticosteroids stand out