Lichen Planus: A Cross-Sectional Evaluation of US Dermatologists' Comorbidity Screening and Management Patterns

Lichen planus (LP) is a chronic inflammatory dermatosis affecting up to 0.91% of the US's population. LP is associated with various comorbid conditions, among them autoimmune conditions. LP has various treatment strategies, although none are US Food and Drug Administration (FDA)-approved; this is further complicated by the lack of any clinical or expert guidelines. This study aimed to explore dermatology practitioners' comorbidity screening patterns and treatment practices for management of LP.

An institutional review board (IRB)-approved, anonymous survey was distributed to members of the ODAC Conference listserv, targeting dermatology practitioners. The survey collected data on demographics, comorbidity screening, and treatment strategies.

A total of 406 respondents (17.4% response rate) participated. Hepatitis C virus was the most screened for condition (91.0%), despite its overall low prevalence in patients with LP. Screening rates for highly prevalent comorbidities such as hypertension (10.1%), dyslipidemia (9.7%), depression (18.7%), and anxiety (17.3%) were low. Importantly, almost one-third (32.5%) of respondents reported performing no screening for any comorbid conditions. Topical corticosteroids were the most prescribed therapy (97.8%), followed by topical calcineurin inhibitors (67.7%) and intralesional corticosteroids (64.8%), consistent with high-level evidence for their use in LP treatment. Phototherapy and systemic treatments, including oral immunosuppressants and retinoids, were less frequently utilized despite strong evidence supporting their use.

These data highlight gaps in the comorbidity screening practices among dermatology practitioners managing LP, with significant underscreening for prevalent conditions. While respondents commonly relied on some evidence-based topical treatments, there is notable underutilization of systemic treatments for moderate to severe disease. These results emphasize the need for clinical guidelines for LP management, aiming to enhance patient care and outcomes.