## First-Line Topical Management of Oral Lichen Planus **Key Point:** Topical corticosteroids are the gold standard for symptomatic oral lichen planus, particularly when erosions are present and causing pain or functional impairment. ### Why Triamcinolone Acetonide? **High-Yield:** Triamcinolone acetonide 0.1% in paste or ointment form is preferred for oral lichen planus because: - High potency (Class III) corticosteroid suitable for mucous membranes - Paste formulation adheres well to oral mucosa, prolonging contact time - Rapid anti-inflammatory effect on erosive lesions - Reduces pain and promotes healing - Safe for short-term use in oral cavity (minimal systemic absorption) ### Treatment Algorithm for Oral Lichen Planus ```mermaid flowchart TD A[Oral Lichen Planus]:::outcome --> B{Symptomatic?}:::decision B -->|No/Mild| C[Observation or topical corticosteroid]:::action B -->|Moderate-Severe/Erosive| D[Topical corticosteroid: Triamcinolone 0.1%]:::action D --> E{Response in 2-4 weeks?}:::decision E -->|Yes| F[Continue, taper gradually]:::action E -->|No| G[Intralesional corticosteroid or systemic therapy]:::action G --> H[Consider retinoids or immunosuppressants]:::action ``` ### Dosing & Application **Clinical Pearl:** Apply triamcinolone paste 2–3 times daily after meals and at bedtime. Instruct patient not to eat or drink for 30 minutes after application to maximize contact time. Typical duration: 2–4 weeks. ### Monitoring - Reassess at 2–4 weeks - If erosions persist or worsen → consider intralesional triamcinolone (10 mg/mL) or systemic corticosteroids - Long-term topical steroids risk candidiasis → monitor for oral thrush **Mnemonic:** **TACO** = **T**opical **A**cetate **C**orticosteroid **O**ral (Triamcinolone Acetonide for oral lichen planus)
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