You Lichen This? Management of Lichenoid Disease, LPP, and More

Daniela Kroshinsky, MD, MPH delivered a comprehensive clinical update on the diagnosis and management of lichenoid diseases, including lichen planus (LP), lichen planus pigmentosus (LPP), and immune checkpoint inhibitor–associated lichenoid eruptions. Dr Kroshinsky reviewed the heterogeneity of LP subtypes and emphasized the importance of evaluating for mucosal involvement, which can occur in a majority of patients with cutaneous disease and may carry risks such as dysphagia, strictures, and squamous cell carcinoma.

Systemic treatment options for refractory LP were highlighted, with particular focus on emerging data for Janus kinase (JAK) inhibitors and oral apremilast. Evidence from a systematic review of 56 patients demonstrated that JAK inhibitors produced clinical responses within days to weeks across LP subtypes, though patient selection remains important given reported risks of venous thromboembolism, cardiovascular events, malignancy, and serious infection. A pilot study of apremilast in moderate-to-severe cutaneous LP showed improvement in all treated patients by 12 weeks, with headaches and nausea identified as the most frequent adverse effects. Traditional systemic agents, including cyclosporine, were also reviewed as effective options with rapid onset when appropriately dosed and monitored. 

Dr Kroshinsky also addressed management strategies for lichenoid eruptions associated with immune checkpoint inhibitors, which can occur in up to 17% of patients receiving immunotherapy. Long-term systemic corticosteroids were discouraged due to potential attenuation of antitumor efficacy, with low-dose methotrexate and systemic retinoids identified as commonly used nonsteroidal maintenance therapies. Emerging biologic options were discussed with emphasis on using the most targeted therapy possible to limit broader immune suppression. The presentation concluded with therapeutic updates for LPP, underscoring the importance of early intervention and reviewing data supporting isotretinoin, oral tranexamic acid, and low-fluence Q-switched Nd:YAG laser toning as treatment options for stable disease.