Lichen Planus Treatments: Hype vs. Reality

Lichen planus (LP) is a tricky condition, and a recent study I came across highlights just how murky the waters of treatment can get. According to the research, “Treatment for LP is disappointing and controversial.

Reported treatment options include topical and systemic steroids:

• retinoids
• azathioprine
• dapsone
• cyclosporine A
• griseofulvin,
• methotrexate
• cyclophosphamide
• hydroxychloroquine
• tacrolimus
• interferon-α

 (source).
That’s quite a laundry list, and it’s telling that even the experts can’t seem to agree on what works best.

Just a few days ago, I shared another study showing methotrexate has a 73% effectiveness rate for LP—a pretty solid number compared to the uncertainty around other options. Even these studies do not specify whether all participants had a biopsy done before participating.

Meanwhile Online

Meanwhile, I’ve heard from folks in online communities who swear by hydroxychloroquine, claiming it’s been a game-changer for them. But here’s the kicker: if the study calls these treatments “disappointing and controversial,” shouldn’t that label apply to all of them, including the darlings of patient forums? 

Phototherapy Angle

Then there’s the phototherapy angle—UVB and PUVA treatments. The study mentions these but leaves out critical details. It casually notes remission rates “regardless of UVB dose and duration,” which sounds promising until you realize they don’t specify what “dose” or “duration” even means. Are we talking one low-dose session or months of intense exposure? Without that context, it’s hard to know if someone with minimal treatment has the same shot at remission as someone blasted with UV for weeks. Oh, and here’s a glaring omission: no mention of how many participants ended up with skin cancer after all that UV exposure. That’s a pretty big “oops” for a follow-up study. No mention was made of biopsy results on participants either- one of our biggest concerns. We know that sunlight does work on many fungal infections.

My Point

This brings me to my main point: when you dig into research like this, you’ve got to read between the lines. Who’s funding the study? Are they prioritizing patient outcomes, or are they serving the interests of the folks cutting the checks? A list of treatments and some vague stats might look impressive, but it’s on us to ask the tough questions the authors don’t always answer.

Check out the full study here and see what you think. Have you tried any of these treatments? Drop your thoughts below—I’d love to hear what’s worked (or hasn’t) for you.