A patient is diagnosed with symptomatic oral lichen planus with erosive lesions. What is the first-line treatment?

Correct answer: C. Topical corticosteroids (e.g., triamcinolone acetonide)

• A. Antivirals treat herpetic infections. Lichen planus is an autoimmune/inflammatory condition, not viral.
• B. Antifungal agents treat candidiasis. While Candida can superinfect steroid-treated LP lesions (monitor for this), antifungals are not the primary treatment for lichen planus itself.
• C. CORRECT. Topical corticosteroids are the first-line treatment for symptomatic oral lichen planus, particularly erosive or ulcerative forms. Triamcinolone acetonide in an adhesive base (Orabase) or fluocinonide gel reduces inflammation and promotes epithelial healing. Systemic corticosteroids are reserved for severe, refractory cases.
• D. Surgical excision is not indicated for lichen planus — it is not a neoplasm and excision would not address the underlying autoimmune process. Excision might be considered if a specific lesion shows dysplasia on biopsy.