治疗扁平苔藓 (LP) 会用到不同类型和形式的大量药物；皮质类固醇（局部/系统性）、维 A 酸类药物、钙调磷酸酶抑制剂、免疫抑制剂和光疗可能都会用到。[38]Usatine RP, Tinitigan M. Diagnosis and treatment of lichen planus. Am Fam Physician. 2011;84:53-60.http://www.ncbi.nlm.nih.gov/pubmed/21766756?tool=bestpractice.com然而，评估这些药物的疗效比较困难，因为数据大多来自一系列小规模患者或病例报告，而没有足够的对照试验。[45]Thongprasom K, Carrozzo M, Furness S, et al. Interventions for treating oral lichen planus. Cochrane Database Syst Rev. 2011;(7):CD001168.http://www.ncbi.nlm.nih.gov/pubmed/21735381?tool=bestpractice.com在大多数病例中，对症治疗通常已足够，因为一段时间后，皮肤和口腔 LP可能自动缓解。系统性治疗通常专用于更为严重的疾病。在所有病例中，应在开始治疗前考虑药物诱发 LP 的可能性。[39]Asarch A, Gottlieb AB, Lee J, et al. Lichen planus-like eruptions: an emerging side effect of tumor nectosis factor-alpha antagonists. J Am Acad Dermatol. 2009;61:104-111.http://www.ncbi.nlm.nih.gov/pubmed/19539844?tool=bestpractice.com
皮肤疾病
在轻度病例中，强效的局部皮质类固醇霜剂和软膏用于一线治疗。[38]Usatine RP, Tinitigan M. Diagnosis and treatment of lichen planus. Am Fam Physician. 2011;84:53-60.http://www.ncbi.nlm.nih.gov/pubmed/21766756?tool=bestpractice.com抗组胺药物可用作辅助药来减轻瘙痒。强效局部皮质类固醇封包或病灶内应用皮质类固醇对于治疗肥厚型 LP 斑块可能有益。严重病例（具有显著刺激性，泛发点滴状 LP）可能需要使用系统性皮质类固醇治疗。[46]Kellet JK, Ead RD. Treatment of lichen planus with short course of oral prednisolone. Br J Dermatol. 1990;123:550-551.http://www.ncbi.nlm.nih.gov/pubmed/2095191?tool=bestpractice.com[2]Boyd AS, Neldner KN. Lichen planus. J Am Acad Dermatol. 1991;25:593-619.http://www.ncbi.nlm.nih.gov/pubmed/1791218?tool=bestpractice.com可连续治疗 2~6 周，然后在接下来数周内逐渐降低剂量。尽可能早地逐渐降低局部/系统性皮质类固醇的强度/剂量对于避免出现皮肤不良反应很重要。除非 LP 范围广泛，否则肾上腺抑制的风险低。
在治疗顽固性 LP 时，系统性皮质类固醇仍然是普遍采用的策略。作为二线治疗，有口服维 A 酸类药物有效的报道。[47]Laurberg G, Geiger JM, Hjorth N, et al. Treatment of lichen planus with acitretin: a double-blind, placebo-controlled study in 65 patients. J Am Acad Dermatol. 1991;24:434-437.http://www.ncbi.nlm.nih.gov/pubmed/1829465?tool=bestpractice.com然而，由于该类疾病具有顽固性，因此在停药以后可能复发，需要长期维持性治疗。光疗（宽谱或窄谱中波紫外线、口服或浸浴光化学疗法联合补骨脂素 [PUVA] 和UVA1 光疗）可用作有效的二线单一治疗或辅助治疗。[48]Pavlotsky F, Nathansohn N, Kriger G, et al. Ultraviolet-B treatment for cutaneous lichen planus: our experience with 50 patients. Photodermatol Photoimmunol Photomed. 2008;24:83-86.http://www.ncbi.nlm.nih.gov/pubmed/18353088?tool=bestpractice.com[49]Saricaoglu H, Karadogan SK, Baskan EB, et al. Narrowband UVB therapy in the treatment of lichen planus. Photodermatol Photoimmunol Photomed. 2003;19:265-267.http://www.ncbi.nlm.nih.gov/pubmed/14535898?tool=bestpractice.com[50]Taneja A, Taylor CR. Narrow-band UVB for lichen planus treatment. Int J Dermatol. 2002;41:282-283.http://www.ncbi.nlm.nih.gov/pubmed/12100704?tool=bestpractice.com[51]Gonzalez E, Momtaz-T K, Freedman S. Bilateral comparison of generalized lichen planus treated with psoralens and ultraviolet A. J Am Acad Dermatol. 1984;10:958-961.http://www.ncbi.nlm.nih.gov/pubmed/6736339?tool=bestpractice.com鉴于潜在不良反应，中波紫外线通常是比PUVA更好的选择。在维 A 酸类药物和系统性皮质类固醇抵抗的重度病例，口服环孢素可能有效。[52]Pigatto PD, Chiappino G, Bigardi A, et al. Cyclosporin A for treatment of severe lichen planus. Br J Dermatol. 1990;122:121-123.http://www.ncbi.nlm.nih.gov/pubmed/2297500?tool=bestpractice.com[53]Ho VC, Gupta AK, Ellis CN, et al. Treatment of severe lichen planus with cyclosporine. J Am Acad Dermatol. 1990;22:64-68.http://www.ncbi.nlm.nih.gov/pubmed/2298966?tool=bestpractice.com然而，长期使用与肾毒性相关，并且 LP 可能会在停药时复发。重度皮肤 LP 治疗中使用的其他药剂包括灰黄霉素、[54]Massa MC, Rogers RS 3rd. Griseofulvin therapy of lichen planus. Acta Derm Venereol. 1981;61:547-550.http://www.ncbi.nlm.nih.gov/pubmed/6177168?tool=bestpractice.com甲硝唑、[55]Shelley WB, Shelley ED. Urinary tract infection as a cause of lichen planus: metronidazole therapy. J Am Acad Dermatol 1984;10:905-907.http://www.ncbi.nlm.nih.gov/pubmed/6725678?tool=bestpractice.com[56]Büyük AY, Kavala M. Oral metronidazole treatment of lichen planus. J Am Acad Dermatol. 2000;43:260-262.http://www.ncbi.nlm.nih.gov/pubmed/10906648?tool=bestpractice.com[57]Wahba-Yahav AV. Idiopathic lichen planus: treatment with metronidazole. J Am Acad Dermatol. 1995;33:301-302.http://www.ncbi.nlm.nih.gov/pubmed/7622660?tool=bestpractice.com柳氮磺胺吡啶、[58]Bauza A, Espana A, Gil P, et al. Successful treatment of lichen planus with sulfasalazine in 20 patients. Int J Dermatol. 2005;44:158-162.http://www.ncbi.nlm.nih.gov/pubmed/15689219?tool=bestpractice.com硫唑嘌呤、[59]Verma KK, Sirka CS, Khaitan BK. Generalized severe lichen planus treated with azathioprine. Acta Derm Venereol. 1999;79:493.http://www.ncbi.nlm.nih.gov/pubmed/10598780?tool=bestpractice.com[60]Verma KK, Mittal R, Manchanda Y. Azathioprine for the treatment of severe erosive oral and generalized lichen planus. Acta Derm Venereol. 2001;81:378-379.http://www.ncbi.nlm.nih.gov/pubmed/11800155?tool=bestpractice.com[61]Lear JT, English JSC. Erosive and generalized lichen planus responsive to azathioprine. Br J Dermatol. 1996;21:56-57.http://www.ncbi.nlm.nih.gov/pubmed/8689773?tool=bestpractice.com麦考酚酯、[62]Nousari HC, Goyal S, Anhalt GJ. Successful treatment of resistant hypertrophic and bullous lichen planus with mycophenolate mofetil. Arch Dermatol. 1999;135:1420-1421.http://www.ncbi.nlm.nih.gov/pubmed/10566854?tool=bestpractice.com甲氨蝶呤、[63]Turan H, Baskan EB, Tunali S, et al. Methotrexate for the treatment of generalized lichen planus. J Am Acad Dermatol. 2009;60:164-166.http://www.ncbi.nlm.nih.gov/pubmed/19103373?tool=bestpractice.com[64]Hazra SC, Choudhury AM, Khondker L, et al. Comparative efficacy of methotrexate and mini pulse betamethasone in the treatment of lichen planus. Mymensingh Med J. 2013;22:787-797.http://www.ncbi.nlm.nih.gov/pubmed/24292313?tool=bestpractice.com和阿法赛特生物制剂。[65]Fivenson DP, Mathes B. Treatment of generalized lichen planus with alefacept. Arch Dermatol 2006;142:151-152.http://archderm.ama-assn.org/cgi/content/full/142/2/151http://www.ncbi.nlm.nih.gov/pubmed/16490842?tool=bestpractice.com
头皮损害（毛发扁平苔藓）
一线治疗为强效局部皮质类固醇。[38]Usatine RP, Tinitigan M. Diagnosis and treatment of lichen planus. Am Fam Physician. 2011;84:53-60.http://www.ncbi.nlm.nih.gov/pubmed/21766756?tool=bestpractice.com[66]Assouly P, Reygagne P. Lichen planopilaris: update on diagnosis and treatment. Semin Cutan Med Surg. 2009;28:3-10.http://www.ncbi.nlm.nih.gov/pubmed/19341936?tool=bestpractice.com[67]Kang H, Alzolibani AA, Otberg N, et al. Lichen planopilaris. Dermatol Ther. 2008;21:249-256.http://www.ncbi.nlm.nih.gov/pubmed/18715294?tool=bestpractice.com[68]Chieregato C, Zini A, Barba A, et al. Lichen planopilaris: report of 30 cases and review of the literature. Int J Dermatol. 2003;42:342-345.http://www.ncbi.nlm.nih.gov/pubmed/12755968?tool=bestpractice.com重症疾病的治疗可能需要使用皮损内或系统性皮质类固醇。[66]Assouly P, Reygagne P. Lichen planopilaris: update on diagnosis and treatment. Semin Cutan Med Surg. 2009;28:3-10.http://www.ncbi.nlm.nih.gov/pubmed/19341936?tool=bestpractice.com[67]Kang H, Alzolibani AA, Otberg N, et al. Lichen planopilaris. Dermatol Ther. 2008;21:249-256.http://www.ncbi.nlm.nih.gov/pubmed/18715294?tool=bestpractice.com二线治疗方案包括口服维 A 酸类药物和四环素类抗生素。[6]Cevasco NC, Bergfeld WF, Remzi BK, et al. A case-series of 29 patients with lichen planopilaris: the Cleveland Clinic Foundation experience on evaluation, diagnosis, and treatment. J Am Acad Dermatol. 2007;57:47-53.http://www.ncbi.nlm.nih.gov/pubmed/17467854?tool=bestpractice.com
对于一线治疗和二线治疗均难处理的持久未愈患者，可使用节省皮质类固醇用量的免疫抑制剂治疗联合系统性皮质类固醇或者单独使用该类药物进行单一治疗。[68]Chieregato C, Zini A, Barba A, et al. Lichen planopilaris: report of 30 cases and review of the literature. Int J Dermatol. 2003;42:342-345.http://www.ncbi.nlm.nih.gov/pubmed/12755968?tool=bestpractice.com[69]Mirmirani P, Willey A, Price VH. Short course of oral cyclosporine in lichen planopilaris. J Am Acad Dermatol. 2003;49:667-671.http://www.ncbi.nlm.nih.gov/pubmed/14512914?tool=bestpractice.com[70]Tursen U, Api H, Kaya T, et al. Treatment of lichen planopilaris with mycophenolate mofetil. Dermatol Online J. 2004;10:24.http://www.ncbi.nlm.nih.gov/pubmed/15347506?tool=bestpractice.com[66]Assouly P, Reygagne P. Lichen planopilaris: update on diagnosis and treatment. Semin Cutan Med Surg. 2009;28:3-10.http://www.ncbi.nlm.nih.gov/pubmed/19341936?tool=bestpractice.com[67]Kang H, Alzolibani AA, Otberg N, et al. Lichen planopilaris. Dermatol Ther. 2008;21:249-256.http://www.ncbi.nlm.nih.gov/pubmed/18715294?tool=bestpractice.com
口腔损害
无症状非溃疡性口腔 LP 无需治疗。症状性口腔 LP 的治疗目的是使疼痛的溃疡和水疱区域愈合。[71]Scully C, Carrozzo M. Oral mucosal disease: Lichen planus. Br J Oral Maxillofac Surg. 2008;46:15-21.http://www.ncbi.nlm.nih.gov/pubmed/17822813?tool=bestpractice.com患者保持高度的口腔卫生并避免引起口腔创伤的外伤原因（如假牙不合适）是极其重要的。
症状性非溃疡性 LP 的最佳治疗方式是使用屏障剂和/或局部麻醉剂作为漱口水或凝胶。[71]Scully C, Carrozzo M. Oral mucosal disease: Lichen planus. Br J Oral Maxillofac Surg. 2008;46:15-21.http://www.ncbi.nlm.nih.gov/pubmed/17822813?tool=bestpractice.com可考虑的药剂包括苄达明漱口水、局部利多卡因和芦荟胶。[71]Scully C, Carrozzo M. Oral mucosal disease: Lichen planus. Br J Oral Maxillofac Surg. 2008;46:15-21.http://www.ncbi.nlm.nih.gov/pubmed/17822813?tool=bestpractice.com[72]Reddy RL, Reddy RS, Ramesh T, et al. Randomized trial of aloe vera gel vs triamcinolone acetonide ointment in the treatment of oral lichen planus. Quintessence Int. 2012;43:793-800.http://www.ncbi.nlm.nih.gov/pubmed/23041995?tool=bestpractice.com止痛药（例如，对乙酰氨基酚）可为某些患者缓解疼痛；然而，非甾体抗炎药可能会使症状恶化，因此应在决定镇痛前请教专科医生。
萎缩性/溃疡性口腔 LP 的最佳治疗方案是使用口腔专用的局部皮质类固醇制剂。[73]Davari P, Hsiao HH, Fazel N. Mucosal lichen planus: an evidence-based treatment update. Am J Clin Dermatol. 2014;15:181-195.http://www.ncbi.nlm.nih.gov/pubmed/24781705?tool=bestpractice.com可使用各种不同的药剂。[71]Scully C, Carrozzo M. Oral mucosal disease: Lichen planus. Br J Oral Maxillofac Surg. 2008;46:15-21.http://www.ncbi.nlm.nih.gov/pubmed/17822813?tool=bestpractice.com[74]Ho J, Hantash BM. Systematic review of current systemic treatment options for erosive lichen planus. Expert Review of Dermatology. 2012;7:269-282.http://www.expert-reviews.com/doi/pdf/10.1586/edm.12.20[75]Carbone M, Conrotto D, Carrozzo M, et al. Topical corticosteroids in association with miconazole and chlorhexidine in the long-term management of atrophic-erosive oral lichen planus: a placebo-controlled and comparative study between clobetasol and fluocinonide. Oral Dis. 1999;5:44-49.http://www.ncbi.nlm.nih.gov/pubmed/10218041?tool=bestpractice.com[76]Lozada-Nur F, Miranda C, Maliksi R. Double-blind clinical trial of 0.05% clobetasol propionate (corrected from proprionate) ointment in orabase and 0.05% fluocinonide ointment in orabase in the treatment of patients with oral vesiculoerosive diseases. Oral Surg Oral Med Oral Pathol. 1994;77:598-604.http://www.ncbi.nlm.nih.gov/pubmed/8065723?tool=bestpractice.com[77]Thongprasom K, Luengvisut P, Wongwatanakij A, et al. Clinical evaluation in treatment of oral lichen planus with topical fluocinolone acetonide: a 2-year follow-up. J Oral Pathol Med. 2003;32:315-322.http://www.ncbi.nlm.nih.gov/pubmed/12787037?tool=bestpractice.com[78]Tyldesley WR, Harding SM. Betamethasone valerate aerosol in the treatment of oral lichen planus. Br J Dermatol. 1977;96:659-662.http://www.ncbi.nlm.nih.gov/pubmed/326295?tool=bestpractice.com[79]Voute AB, Schulten EA, Langendijk PN, et al. Fluocinonide in an adhesive base for treatment of oral lichen planus: a double-blind, placebo-controlled clinical study. Oral Surg Oral Med Oral Pathol. 1993;75:181-185.http://www.ncbi.nlm.nih.gov/pubmed/8426717?tool=bestpractice.com重要的是，在情况允许时逐渐减少皮质类固醇的强度或剂量以避免出现副作用。联合局部抗真菌治疗可防范口咽念珠菌病。
至于对局部措施无反应的重症，通常以短期系统性皮质类固醇治疗，并以局部皮质类固醇进一步维持治疗。[71]Scully C, Carrozzo M. Oral mucosal disease: Lichen planus. Br J Oral Maxillofac Surg. 2008;46:15-21.http://www.ncbi.nlm.nih.gov/pubmed/17822813?tool=bestpractice.com顽固性口腔损害所采用的其他治疗包括硫唑嘌呤、[60]Verma KK, Mittal R, Manchanda Y. Azathioprine for the treatment of severe erosive oral and generalized lichen planus. Acta Derm Venereol. 2001;81:378-379.http://www.ncbi.nlm.nih.gov/pubmed/11800155?tool=bestpractice.com局部或口服维 A 酸类药物、[80]Boisnic S, Licu D, Ben Slama L, et al. Topical retinaldehyde treatment in oral lichen planus and leukoplakia. Int J Tissue React. 2002;24:123-130.http://www.ncbi.nlm.nih.gov/pubmed/12779246?tool=bestpractice.com[81]Buajeeb W, Kraivaphan P, Pobrurksa C. Efficacy of topical retinoic acid compared with topical fluocinolone acetonide in the treatment of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83:21-25.http://www.ncbi.nlm.nih.gov/pubmed/9007918?tool=bestpractice.com[82]Giustina TA, Stewart JC, Ellis CN, et al. Topical application of isotretinoin gel improves oral lichen planus: a double-blind study. Arch Dermatol. 1986;122:534-536.http://www.ncbi.nlm.nih.gov/pubmed/3518638?tool=bestpractice.com[83]Hersle K, Mobacken H, Sloberg K, et al. Severe oral lichen planus: treatment with an aromatic retinoid (etretinate). Br J Dermatol. 1982;106:77-80.http://www.ncbi.nlm.nih.gov/pubmed/7037037?tool=bestpractice.com[84]Petruzzi M, De Benedittis M, Grassi R, et al. Oral lichen planus: a preliminary clinical study on treatment with tazarotene. Oral Dis. 2002;8:291-295.http://www.ncbi.nlm.nih.gov/pubmed/12477060?tool=bestpractice.com[85]Sloberg K, Hersle K, Mobacken H, et al. Severe oral lichen planus: remission and maintenance with vitamin A analogues. J Oral Pathol. 1983;12:473-477.http://www.ncbi.nlm.nih.gov/pubmed/6418869?tool=bestpractice.com[86]Zegarelli DJ. Treatment of oral lichen planus with topical vitamin A acid. J Oral Med. 1984;39:186-191.http://www.ncbi.nlm.nih.gov/pubmed/6592303?tool=bestpractice.com[87]Petruzzi M, Lucchese A, Lajolo C, et al. Topical retinoids in oral lichen planus treatment: an overview. Dermatology. 2013;226:61-67.http://www.ncbi.nlm.nih.gov/pubmed/23548887?tool=bestpractice.com局部钙调磷酸酶抑制剂、[88]Samycia M, Lin AN. Efficacy of topical calcineurin inhibitors in lichen planus. J Cutan Med Surg. 2012;16:221-229.http://www.ncbi.nlm.nih.gov/pubmed/22784514?tool=bestpractice.com[89]Al Johani KA, Hegarty AM, Porter SR, et al. Calcineurin inhibitors in oral medicine. J Am Acad Dermatol. 2009;61:829-840.http://www.ncbi.nlm.nih.gov/pubmed/19836643?tool=bestpractice.com[90]Byrd JA, Davis MD, Bruce AJ, et al. Response of oral lichen planus to topical tacrolimus in 37 patients. Arch Dermatol. 2004;140:1508-1512.http://archderm.ama-assn.org/cgi/content/full/140/12/1508http://www.ncbi.nlm.nih.gov/pubmed/15611431?tool=bestpractice.com[91]Hodgson TA, Sahni N, Kaliakatsou F, et al. Long-term efficacy and safety of topical tacrolimus in the management of ulcerative/erosive oral lichen planus. Eur J Dermatol. 2003;13:466-470.http://www.ncbi.nlm.nih.gov/pubmed/14693491?tool=bestpractice.com[92]Kaliakatsou F, Hodgson TA, Lewsey JD, et al. Management of recalcitrant ulcerative oral lichen planus with topical tacrolimus. J Am Acad Dermatol. 2002;46:35-41.http://www.ncbi.nlm.nih.gov/pubmed/11756943?tool=bestpractice.com[93]Lozada-Nur FI, Sroussi HY. Tacrolimus powder in Orabase 0.1% for the treatment of oral lichen planus and oral lichenoid lesions: an open clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:744-749.http://www.ncbi.nlm.nih.gov/pubmed/17138176?tool=bestpractice.com[94]Olivier V, Lacour JP, Mousnier A, et al. Treatment of chronic erosive oral lichen planus with low concentrations of topical tacrolimus: an open prospective study. Arch Dermatol. 2002;138:1335-1338.http://archderm.ama-assn.org/cgi/content/full/138/10/1335http://www.ncbi.nlm.nih.gov/pubmed/12374539?tool=bestpractice.com[95]Rozycki TW, Rogers RS 3rd, Pittelkow MR, et al. Topical tacrolimus in the treatment of symptomatic oral lichen planus: a series of 13 patients. J Am Acad Dermatol. 2002;46:27-34.http://www.ncbi.nlm.nih.gov/pubmed/11756942?tool=bestpractice.com[96]Volz T, Caroli U, Ludtke H, et al. Pimecrolimus cream 1% in erosive oral lichen planus – a prospective randomized double blind vehicle controlled study. Br J Dermatol. 2008;159:936-941.http://www.ncbi.nlm.nih.gov/pubmed/18647310?tool=bestpractice.com[97]Radfar L, Wild RC, Suresh L. A comparative treatment study of topical tacrolimus and clobetasol in oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:187-193.http://www.ncbi.nlm.nih.gov/pubmed/18230389?tool=bestpractice.com[98]Dissemond J. Pimecrolimus in an adhesive ointment is safe and effective in long-term treatment for oral lichen planus. J Eur Acad Dermatol Venereol. 2008;22:1009-1011.http://www.ncbi.nlm.nih.gov/pubmed/18194236?tool=bestpractice.com[99]Day I, Lin AN. Use of pimecrolimus cream in disorders other than atopic dermatitis. J Cutan Med Surg. 2008;12:17-26.http://www.ncbi.nlm.nih.gov/pubmed/18258153?tool=bestpractice.com麦考酚酯或甲氨蝶呤，不过相关疗效数据非常有限。[45]Thongprasom K, Carrozzo M, Furness S, et al. Interventions for treating oral lichen planus. Cochrane Database Syst Rev. 2011;(7):CD001168.http://www.ncbi.nlm.nih.gov/pubmed/21735381?tool=bestpractice.com[88]Samycia M, Lin AN. Efficacy of topical calcineurin inhibitors in lichen planus. J Cutan Med Surg. 2012;16:221-229.http://www.ncbi.nlm.nih.gov/pubmed/22784514?tool=bestpractice.com[100]Cheng S, Kirtschig G, Cooper S, et al. Interventions for erosive lichen planus affecting mucosal sites. Cochrane Database Syst Rev. 2012;(2):CD008092.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008092.pub2/pdfhttp://www.ncbi.nlm.nih.gov/pubmed/22336835?tool=bestpractice.com[101]Lodi G, Carrozzo M, Furness S, et al. Interventions for treating oral lichen planus: a systematic review. Br J Dermatol. 2012;166:938-947.http://www.ncbi.nlm.nih.gov/pubmed/22242640?tool=bestpractice.com虽然相关证据非常有限，但是他克莫司促使黏膜恶性转化的潜能已经受到关注。结合口腔 LP 高达 1.75% 的恶性转化风险，对于接受局部钙调磷酸酶抑制剂治疗的患者，尤其是具有糜烂性和溃疡性损害的患者开展监测是极为重要的。
沙利度胺是一种兼具疗效和口腔癌预防潜能的药剂，但相关数据有限。[102]Jin X, Lu S, Xing X, et al. Thalidomide: features and potential significance in oral precancerous conditions and oral cancer. J Oral Pathol Med. 2013;42:355-362.http://www.ncbi.nlm.nih.gov/pubmed/22978368?tool=bestpractice.com此外还主张使用激光疗法和阿法赛特，但是疗效数据有限，并且不建议常规使用。
生殖器黏膜疾病
强效皮质类固醇仍然是治疗的主要手段。[103]Cooper SM, Wojnarowska F. Influence of treatment of erosive lichen planus of the vulva on its prognosis. Arch Dermatol. 2006;142:289-294.http://archderm.ama-assn.org/cgi/content/full/142/3/289http://www.ncbi.nlm.nih.gov/pubmed/16549703?tool=bestpractice.com[104]Edwards SK, Bates CM, Lewis F, et al. 2014 UK national guideline on the management of vulval conditions. Int J STD AIDS. 2015;26:611-624.http://www.ncbi.nlm.nih.gov/pubmed/25300587?tool=bestpractice.com二线治疗可使用局部钙调神经磷酸酶抑制剂。[105]Byrd JA, Davis MD, Rogers RS 3rd. Recalcitrant symptomatic vulvar lichen planus: response to topical tacrolimus. Arch Dermatol. 2004;140:715-720.http://archderm.ama-assn.org/cgi/content/full/140/6/715http://www.ncbi.nlm.nih.gov/pubmed/15210463?tool=bestpractice.com[106]Lonsdale-Eccles AA, Velangi S. Topical pimecrolimus in the treatment of genital lichen planus: a prospective case series. Br J Dermatol. 2005;153:390-394.http://www.ncbi.nlm.nih.gov/pubmed/16086755?tool=bestpractice.com[107]Goldstein AT, Thaci D, Luger T. Topical calcineurin inhibitors for the treatment of vulvar dermatoses. Eur J Obstet Gynecol Reprod Biol. 2009;146:22-29.http://www.ncbi.nlm.nih.gov/pubmed/19631446?tool=bestpractice.com由于钙调磷酸酶抑制剂具有增强恶性转化可能性的理论风险，随访时需要仔细评估正在使用该药剂的患者。
对于持久难愈的重症，可以短期使用系统性皮质类固醇。然而，黏膜疾病所需的剂量更高，应考虑潜在的不良反应。
维 A 酸类、羟基氯喹、环孢菌素、硫唑嘌呤和沙利度胺是使用的其他药物，但是相关疗效数据有限，不建议常规使用。
指/趾甲疾病
累及指/趾甲的扁平苔藓可能难以治疗，许多患者在最初改善后容易复发。将强效局部用皮质类固醇揉搓到甲襞有助于活跃期的治疗。可在局部麻醉情况下，将曲安奈德滴注至近端甲襞。[108]Abell E, Samman PD. Intradermal triamcinolone treatment of nail dystrophies. Br J Dermatol. 1973;89:191-197.http://www.ncbi.nlm.nih.gov/pubmed/4726894?tool=bestpractice.com二线治疗可采用口服皮质类固醇。[44]Weedon D. Skin pathology. 2nd ed. St. Louis, MO: Elsevier Limited; 2002.[109]Tosti A, Peluso AM, Fanti PA, et al. Nail lichen planus: clinical and pathological study of twenty-four patients. J Am Acad Derm. 1993;28:724-730.http://www.ncbi.nlm.nih.gov/pubmed/7684409?tool=bestpractice.com此外还可考虑使用环孢素和硫唑嘌呤，尤其是对于糜烂性指/趾甲疾病。
多处病变部位
目前尚未建立适用于多种形式扁平苔藓患者的治疗指南。这些患者根据具体情况的判定给予治疗。
