Dawaa Reference

chronic

Lichen planus (cutaneous)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

BAD Guidelines for Lichen Planus · Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939) · Prednisolone 5mg tablets SmPC (https://www.medicines.org.uk/emc/product/4921/smpc) · Lichen Planus - StatPearls - NCBI Bookshelf (NBK526126)

Verified against3 documents
  • Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939)
  • Prednisolone 5mg tablets SmPC (https://www.medicines.org.uk/emc/product/4921/smpc)
  • Lichen Planus - disease-level clinical article (lichen-planus-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (9)

  • Itching is typical of the classic papules [itching · papules]
  • Painful, erosive lesions on the soles or between the toes can make walking difficult
  • Burning pain worsened by hot or spicy food occurs with the erosive and atrophic oral forms [atrophy · burning pain]
  • Oesophageal involvement can cause difficulty swallowing [difficulty swallowing]
  • Most people with skin lesions clear spontaneously within 1 to 2 years of first coming in [skin lesions]
  • The oral form is a different animal - it is chronic, and may or may not remit
  • A remission won on treatment is typically followed by relapse, so symptomless oral disease is better left alone - the side-effects of treating it cost more than the disease does [relapse]
  • Drug-induced lichen planus resolves gradually once the medicine behind it is stopped
  • The drug-induced form can be impossible to tell apart from the idiopathic kind

Signs — what you find (12)

  • Lesions follow the 6 P's: purple, polygonal, flat, itchy papules and plaques [itching · papules · plaques]
  • A shiny surface with fine white lacy lines (Wickham striae) is a hallmark, and lesions feel firm [stretch marks]
  • Lesions typically cluster on the flexor wrists, backs of the hands, lower back, ankles, and shins
  • New lesions can appear along scratch lines, the Koebner phenomenon [skin lesions]
  • Resolved lesions often leave grey-brown pigmentation behind
  • The hypertrophic form shows thickened, wart-like red-brown or yellow-grey plaques on the shins and ankles [plaques]
  • Bullous lichen planus produces tense blisters on the legs filled with clear or pale-yellow fluid [blisters · pallor]
  • The most common oral form (reticular) is symptomless white lacy lines on the inner cheeks
  • Nail disease starts with a thinned plate and lengthwise ridging, and can progress to scarring and nail loss [scarring]
  • Scalp disease (lichen planopilaris) shows small red follicular bumps that progress to scarring hair loss [hair loss · scarring]
  • Drug-induced lichen planus favours sun-exposed skin rather than the classic sites
  • Erosive vulval or vaginal disease can leave scarring and narrowing [scarring · stricture]

Tests (4)

  • Dermoscopy shows Wickham striae as white lines with red globules at the edge
  • Patch testing is used when oral lesions sit near dental fillings to check for a metal allergy
  • Biopsy with microscopy is the most reliable way to confirm the diagnosis
  • Direct immunofluorescence on biopsy helps separate lichen planus from lupus

If not this — what else fits (10)

  • Lupus erythematosus is hard to distinguish when only scalp or mouth lesions are present, so biopsy with immunofluorescence is used
  • Hypertrophic lichen planus can closely resemble lichen simplex chronicus
  • Vulvar lichen planus can be hard to tell apart from lichen sclerosus
  • Erythema dyschromicum perstans (ashy dermatosis)
  • Psoriasis
  • Secondary syphilis
  • Pityriasis rosea
  • Lichen nitidus
  • Graft-versus-host disease
  • Keratosis lichenoides chronica

SourceStatPearls "Lichen Planus" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Oral second-line when the topical steroid has not worked | Intralesional injection into plaques that resist clobetasol

MAIN TREATMENT - choose one

1

CLOBETASOL PROPIONATE

1st line

Formtopical

Adult dose and duration

Apply 0.05% ointment thin layer twice daily to pruritic violaceous papules x 2-4 weeks

Paediatric dose

Child: use moderate-potency topical steroid (e.g. clobetasone butyrate 0.05%) under specialist supervision

Dose source

Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939)

Why

Superpotent topical corticosteroid that suppresses the immune-mediated inflammation driving the pruritic, violaceous papules of cutaneous lichen planus.

Cautions
  • Clobetasol propionate is a superpotent topical corticosteroid; do not use continuously for >4 weeks without medical review.
  • Avoid face, axillae, and groin.
  • Screen for hepatitis C virus infection in patients with extensive lichen planus.
  • Ceilings the label sets: no more than 50 g in a week, no longer than 4 weeks, courses kept to about five days where possible and reviewed weekly. If it is still needed after that, step down to a weaker steroid and keep an emollient going. Clobetasol is the most potent class - atrophy and adrenal suppression are the price of open-ended use.
Egyptian brands
Egyptian brandManufacturerIndicative price
CLOBITAT 0.05% TOPICAL CREAM 15 GMBIORIGINAL INTERNATIONAL GROUP PHARMA EGYPT5.50 EGP
DERMASOL 0.05% CREAM 20 GMUP PHARMA5.50 EGP
DERMASOL 0.05% OINT. 20 GMUP PHARMA5.50 EGP
CLEROVATE 0.05% TOPICAL OINT. 25 GMMARCYRL PHARMACEUTICAL INDUSTRIES (MPI)7.50 EGP
CLOVACORT 0.05% OINT. 20 GMEUROPEAN EGYPTIAN PHARM. IND.9.00 EGP
DERMOPHARM 0.05% CREAM 25 GMWESTERN PHARMACEUTICALS INDUSTRIES22.00 EGP
DERMOVATE 0.05% TOP. CREAM 25 GMGLAXO SMITHKLINE44.00 EGP
HEROBETASOL 120 MLSHAMPOOEGPI > HEROPHARM37.50 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Lichen Planus - disease-level clinical article (lichen-planus-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - There is a risk of malignant transformation of oral mucosal lesions into oral squamous cell carcinoma.
3

PREDNISOLONE

2nd line

Strength5 mg

Formoral.solid

Adult dose and duration

30-40 mg once daily for 1-2 weeks, then taper over 3-4 weeks for severe or widespread involvement x 4-6 weeks (tapering course)

Paediatric dose

Specialist pediatric dermatology consultation mandatory

Dose source

Prednisolone 5mg tablets SmPC (https://www.medicines.org.uk/emc/product/4921/smpc)

Why

Reserved for severe, widespread, or disabling lichen planus unresponsive to topical steroids

Cautions
  • Short-term systemic corticosteroid side effects include mood swings, insomnia, elevated blood glucose, and hypertension.
  • Do not stop abruptly after >2 weeks of continuous therapy.
Egyptian brands
Egyptian brandManufacturerIndicative price
HOSTACORTIN H 5MG 30 TAB.SANOFI12.00 EGP (0.40/unit)
PREDNISOLONE 5 MG 20 TABS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.20/unit)
PREDILONE 5MG 10 TAB. (25 STRIPS PACK)KAHIRA250.00 EGP (25.00/unit)
EPICOPRED 5 MG 30 ORODISPERSIBLE TABS.EIPICO69.00 EGP
PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS.EVA PHARMA79.50 EGP
DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS.ANDALOUS PHARMA84.00 EGP
SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS.SANOFI WINTHROP > SANOFI84.00 EGP
ACETASEE 1% EYE DROPS (SUSP.) 5 ML? strength differs? different route - not oral solidRAMEDA7.50 EGP
PREDNIS 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solidPHAROPHARMA9.50 EGP

ORAL SECOND-LINE WHEN THE TOPICAL STEROID HAS NOT WORKED

4

METRONIDAZOLE

Oral second-line when the topical steroid has not worked

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg twice a day x 3 to 8 weeks

Paediatric dose

No paediatric dose for this indication in the sources opened.

Dose source

Lichen Planus - StatPearls - NCBI Bookshelf (NBK526126)

Why

It gives the card something between a failed topical steroid and a course of oral prednisolone. The drug is cheap, needs no blood monitoring, and every Egyptian pharmacy has it. The evidence behind it is small, so offer it as an option to try rather than the expected next step.

Cautions
  • Tell the patient plainly not to drink any alcohol during the course or for a few days after it, because the combination causes violent flushing and vomiting.
  • This is a long course for metronidazole - stop it at once if the patient reports numbness or pins and needles in the hands or feet, which can signal nerve damage.
  • Avoid it in the first trimester of pregnancy.
  • The evidence for metronidazole in lichen planus is limited, so review at the earlier end of the range and stop if nothing has changed.
Egyptian brands
Egyptian brandManufacturerIndicative price
DUMOZOL 500MG 20 F.C. TABS.MINA PHARM > ALPHARMA-DENMARK7.00 EGP (0.35/unit)
ZOLGUARD 500MG 20 TAB.UNIPHARMA CO. > UNIPHARMA9.00 EGP (0.45/unit)
NITROFECTAZOLE 500 MG 20 F.C. TABS.GYPTO PHARMA10.50 EGP (0.53/unit)
FLAGICURE FORTE 500 MG 20 F.C. TABKAHIRA23.00 EGP (1.15/unit)
TRICHOGYL 500MG 12 F.C.TAB.EL NASR15.00 EGP (1.25/unit)
FLAGELLAT FORTE 500MG 20 F.C.TABS.MUP30.00 EGP (1.50/unit)
GEDAZOLE 500MG 20 TAB.JEDCO INT. CO. FOR PHARMACEUTICALS34.00 EGP (1.70/unit)
METROGYPTON 500 MG 20 F.C. TABS.GYPTO PHARMA34.00 EGP (1.70/unit)
DUMOZOL 125MG/5ML SUSP. 125ML? strength differs? different route - not oral solidMINA PHARM > ALPHARMA-DENMARK5.75 EGP
METROZOLE 125MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidMEMPHIS19.50 EGP

INTRALESIONAL INJECTION INTO PLAQUES THAT RESIST CLOBETASOL - give alongside

5

TRIAMCINOLONE ACETONIDE

Intralesional injection into plaques that resist clobetasol

add-on - not a substitute

Forminjection

Adult dose and duration

Injected into the lesion at a strength of 5 to 10 mg/mL

Paediatric dose

No paediatric dose in the sources opened.

Dose source

Lichen Planus - StatPearls - NCBI Bookshelf (NBK526126)

Why

For the patient with a handful of thick, itchy plaques that clobetasol has not flattened, injecting the steroid straight into them treats the lesion without exposing the whole body to a course of oral steroid. It is done in the clinic in a few minutes.

Cautions
  • The ampoule sold in Egypt is far more concentrated than the strength quoted here and must be diluted with saline or local anaesthetic before it is injected into skin.
  • Injecting too much, too often, or too superficially thins the skin and leaves a pale dented scar that may be permanent - keep to a few resistant plaques.
  • Do not inject into skin that looks infected.
  • This treats individual lesions; it does nothing for widespread disease, which needs the oral route or referral.
Egyptian brands
Egyptian brandManufacturerIndicative price
PHARCOCINOLONE 40MG/ML I.M AMP.CHEMIPHARM > PHARCO B8.00 EGP
AMCINOL 40MG/ML I.M AMP.SIGMA TEC11.00 EGP
EPIRELEFAN 40MG/ML I.M AMP.EIPICO38.00 EGP
SYNTHECORTIN 40MG/ML I.M AMP.MUP54.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.