Lichen  planus (LP)  is  a chronic inflammatory mucocutaneous  disease of unknown etiopathogenesis.  Oral mucosa is the  most  commonly involved site followed by skin,  the  vulvar  and  vaginal  mucosa,  glans  penis,  scalp  , and  nails.   Oral LP (OLP) can present as the sole clinical manifestation of the disease or may be associated with cutaneous or other mucosal involvement including the genital area, gastrointestinal tract, and eyes.The estimated worldwide prevalence of oral lichen planus have been found to be ranging from 0.22% to 5 % in different studies, affecting females more than males. The prevalence of oral lichen planus in an Indian study was found to be 2.6%.  The symptomatology of OLP ranges from painless lesions to painful erosive and ulcerative lesions.    

OLP is known to have several clinical subtypes including reticular, erosive, atrophic, papular, plaque-like, and bullous subtypes. Reticular variant, which presents as plaques with interlacing white keratotic lines and surrounded by an erythematous border is the most common subtype. Reticular OLP usually involves  the buccal mucosa, gingiva and sometimes tongue, palate, and lips and is mostly asymptomatic.  Symptoms like burning sensation and pain is usually associated with erosive, atrophic or bullous variants of OLP. Symptomatic oral lichen planus is a painful and debilitating condition having a significant impact over the quality of life of the patient.

Treatment of oral lichen planus can be challenging especially in cases of refractory and extensive disease. The goal of therapy is healing of erosions and improvements in symptoms so that patients can resume their usual eating habits and lifestyle.  Various  treatments  have  been  employed  to  treat  symptomatic  OLP,  but  complete  resolution  is  difficult  to  achieve. The  available  options  of  treatment  of  OLP  are  corticosteroids,  topical  and  systemic  retinoids,  calcineurin  inhibitors  (cyclosporin,  tacrolimus, pimecrolimus),  azathioprine,  phototherapy,  griseofulvin,  hydroxychloroquine,  dapsone, mycophenolate mofetil,  CO2  laser,  thalidomide,  and  low-molecular-weight  heparin,  etc.

Topical corticosteroids remains the mainstay of treatment for oral lichen planus. Topical  corticosteroids  are  preferred  over  systemic  corticosteroids in OLP  owing to their efficacy and lesser risk of serious adverse effects. Superpotent  halogenated  steroids  clobetasol  propionate,  triamcinolone  and  fluocinolone acetonide  have  been  found  to  be  effective.

Systemic acitretin, which is a commonly used modality for treatment for cutaneous lichen planus have also been found to have significant improvement in OLP in a recent case series and a placebo-controlled trial conducted primarily to evaluate the efficacy of acitretin in cutaneous lichen planus. However, there is paucity of robust evidence in favour of the use of systemic acitretin either as monotherapy or in combination with topical corticosteroids in oral lichen planus. The proposed study is aimed to compare the combination of systemic acitretin and topical triamcinolone with placebo and topical triamcinolone in oral lichen planus. This will be a placebo controlled trial where recruited patients of oral lichen planus will be randomized to either of the two intervention groups. The patients and the investigator evaluating the treatment response will both be blinded. This study is an attempt to fill the gap in literature regarding the evidence for the use of systemic acitretin in oral lichen planus.