Prevalence and Treatment Patterns of Lichen Planus in U.S. Adults: A Database Analysis

Lichen planus (LP) is a chronic mucocutaneous inflammatory disease associated with significant morbidity, but comprehensive epidemiologic and therapeutic data have been limited. A recent analysis using the Explorys electronic health record database provides new insights into the prevalence of LP and treatment patterns prescribed by dermatologists in the United States.

Among 566,851 eligible adult patients included in the prevalence analysis, 1,098 were identified as having LP, yielding a crude prevalence of 0.19% (95% CI 0.18–0.21). After adjusting for demographics, the standardized prevalence was 0.15%. LP prevalence was higher among females, with a prevalence ratio of 1.77 compared to males (95% CI 1.53–2.05). The median age of affected individuals was 66 years.

Regarding treatment, more than half of LP patients diagnosed by dermatologists—53% (n = 1061)—remained untreated one year after diagnosis. Among those who initiated therapy, the most common first-line treatment was topical corticosteroids, used in 38% of patients. For individuals treated with systemic immunosuppressive medications, treatment continuation and therapy switching were reported in 28% and 46%, respectively, after one year.

The analysis acknowledges certain limitations. Notably, the lack of a precise diagnostic code for nonoral LP raises the potential for misclassification, and disease severity could not be determined from the available data.

FAQs:

1. What is the estimated prevalence of lichen planus among U.S. adults?
Based on analysis of over 560,000 electronic health records, the standardized prevalence of lichen planus was estimated at 0.15%, with higher rates observed in females (prevalence ratio 1.77). The median age of affected patients was 66 years.

2. How often are patients with lichen planus receiving treatment?
Surprisingly, 53% of patients diagnosed with LP by dermatologists remained untreated one year after diagnosis. This highlights a potential gap in management or limitations in follow-up and care access.

3. What are the most commonly prescribed treatments for lichen planus?
Among those who initiated therapy, topical corticosteroids were the most frequently used first-line treatment, prescribed in 38% of cases. Use of systemic immunosuppressants was less common and often accompanied by therapy discontinuation or switching within a year.

4. What limitations should be considered when interpreting these findings?
The study’s reliance on EHR data introduces some constraints, including the absence of a specific diagnostic code for nonoral LP, which may lead to misclassification. Additionally, disease severity and treatment rationale could not be assessed from the available records.