While it’s important to note that this condition is not a type of cancer, in a small number of cases (perhaps one to three percent) oral cancer has been reported to develop over time. It is unknown whether, in those cases, the lichen planus itself transforms into cancer, or if some early instances of oral cancer are instead initially mistaken for lichen planus. This is possible because some oral pre-cancerous lesions have been shown to mimic lichen planus both clinically and microscopically. That’s one reason why regular monitoring and follow-up is recommended with periodic screenings for oral cancer (a good idea for all patients, even those without oral lichen planus). Ceasing all use of tobacco and alcohol is also helpful, as these are preventable risk factors for oral cancer development.
Cutaneous lichen planus may resolve spontaneously within one to two years, although lichen planus affecting mucous membranes may be more persistent and resistant to treatment. Recurrences are common, even with treatment. Table 4 summarizes the treatment of nongenital cutaneous lichen planus lesions. High-potency topical corticosteroids are first-line therapy for cutaneous lichen planus. 14 – 16 Oral antihistamines (., hydroxyzine [Vistaril]) may be used to control pruritus. Hypertrophic lesions are treated with intralesional triamcinolone acetonide (Kenalog), 5 to 10 mg per mL injection ( to 1 mL per 2-cm lesion). 14
A topical corticosteroid is considered first-line therapy for patients with oral lichen planus. 15 One controlled trial 17 demonstrated the effectiveness of fluocinonide (Lidex) ointment applied to dried oral mucosa six times daily for nine weeks. The steroid, in an adhesive base, was prepared by the pharmacy, although Orabase has also been recommended as an occlusive vehicle. 4 Other topical medications and systemic therapies have been used to treat patients with oral lichen planus 15 that is corticosteroid-resistant. These therapies include topical cyclosporine, systemic corticosteroids, topical and systemic retinoids and oral PUVA.