A 30-year-old female is diagnosed with generalized lichen planus affecting her skin and oral mucosa, causing significant pruritus and discomfort. What is the most appropriate first-line systemic treatment for widespread, symptomatic lichen planus?

Explanation

For widespread, symptomatic, or refractory lichen planus, systemic corticosteroids are generally considered the first-line treatment. They provide rapid anti-inflammatory and immunosuppressive effects, leading to significant improvement in pruritus and skin lesions. While methotrexate, cyclosporine, and oral retinoids (e.g., acitretin) are effective systemic agents for lichen planus, they are typically reserved for cases that are resistant to corticosteroids, for steroid-sparing purposes, or when corticosteroids are contraindicated. Topical corticosteroids are the first-line for localized disease, but for generalized disease, systemic therapy is needed.