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.
Strong Steroid creams/ointments must be used sparingly, no more than a pea size at a time, but depending on how far you spread it. It should be very gently rubbed in, for 10 to 15 seconds. Overdoing the steroid crm/ointmt can cause skin thinning and lessen its effects, Underdoing it can cause rebound effects. That is why you should gradually, i repeat "gradually" reduce the amount and/or frequency of use till you reach what is right for you. Twice a week is successful for many people. some once a week or three times. some lucky people get away with as and when needed. I'm not one of these , alas.
The diagnosis and management of lichen planus, with a focus on cutaneous lichen planus, will be reviewed here. Oral lichen planus, vulvar lichen planus, lichen planopilaris, nail lichen planus, and lichenoid drug eruption (drug-induced lichen planus) are discussed in greater detail separately. (See "Oral lichen planus: Pathogenesis, clinical features, and diagnosis" and "Oral lichen planus: Management and prognosis" and "Lichen planopilaris" and "Vulvar lichen planus" and "Overview of nail disorders", section on 'Lichen planus' and "Lichenoid drug eruption (drug-induced lichen planus)" .)