I have lichen planus. Are there any safer treatment options?

Question

Hello doctor,

I am a 21-year-old female diagnosed with skin lichen planus for the past nine months. My condition tends to spread if I am not on medication, and I have no other significant medical history.

For treatment, my doctor initially prescribed a regimen that included multiple medications, but I was later advised to continue only Rapicort 5 mg (milligram) tablets, which is a steroid, and to gradually taper the dose.

I have been taking Rapicort daily for the past three months.

However, when I attempted to taper the steroid as advised, my skin lesions flared up again. I am concerned about continuing steroid-based treatment long-term and would like an effective plan to control my lichen planus without it spreading.

Unfortunately, I feel my current doctor is overcharging and not providing adequate guidance.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Currently, you are taking Rapicort 5 milligrams daily, and whenever you try to reduce the dose, the rashes flare up again.

Steroids like Rapicort are effective in controlling lichen planus, but they are not safe for long-term use as they can cause:

Weight gain.
Mood changes (irritability, anxiety, depression).
Thinning of bones (osteoporosis).
Menstrual irregularities in women.
Suppression of the body’s natural steroid (cortisol) production

The best approach is to taper the medicine gradually under medical supervision rather than stopping it suddenly. At the same time, safer long-term treatments can be introduced.

These include topical medicines such as Tacrolimus or Pimecrolimus ointments for local lesions, or oral non-steroidal medicines like Hydroxychloroquine, Methotrexate, Azathioprine, or Mycophenolate to help keep the disease under control.

Phototherapy with narrow-band ultraviolet B light can also be considered if the disease is more widespread. Before starting any of these treatments, baseline tests have to be performed, such as:

Blood counts.
Liver function tests.
Kidney function tests.
Blood sugar levels.
Lipid profile.
Screening for hepatitis B.
Screening for hepatitis C.
Screening for HIV.

Along with medication, it is important to avoid scratching or injuring the skin, as lichen planus can spread to areas of injury. Managing stress well and avoiding alcohol and smoking can also help prevent flares.

The condition often resolves over one to two years, but proper management can prevent unnecessary flares and minimize steroid-related side effects. Following a structured treatment plan ensures better long-term control and safer outcomes.

I hope this information helps you.

Thank you.