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Is a biopsy required to confirm the diagnosis of lichen planus?

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Practicing since : 2007
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I have recently been diagnosed with Lichen planus (LP) of the penile glans. I have a history of genital and oral LP. My last outbreak of genital LP which also involved the glans was 15 years ago. I had an outbreak of oral LP a year ago, which is much more settled according to my dentist. My dermatologist diagnosed the recent episode as LP and has advised the use of Clobetasol Propionate 0.05% ointment on the affected area for 2 weeks. He has also asked to see me at the end of 2 weeks. I met my GP today and he strongly advised against the use of Clobetasol Propionate on the glans because of its high potency. He has instead recommended the use of Tacrolimus 0.01% ointment twice a day for 3 weeks and advised follow up at the end of this period. I have suffered from scrotal SCC in the past that was associated with hpv and not with LP. The SCC lesion was caught early, successfully excised and there have been no recurrences after 5 years of intensive follow up. Both the dermatologist and the GP are quite sure that the white patch on the glans is LP and are confident that a biopsy is not needed. I have two questions. Shall I still push for a biopsy or are LP lesions sufficiently distinct from LP that clinical diagnosis is safe? Is Clobetasol propionate safe or should I discontinue it and start using Tacrolimus? I am a 50 year old, obese but otherwise healthy male. I don't have diabetes or blood pressure and my hep C test was clear.
Fri, 11 May 2018 in Skin Hair and Nails
Answered by Dr. Asmeet Kaur Sawhney 32 minutes later
Brief Answer:
No need of biopsy at this point

Detailed Answer:
Thanks for writing to us at HealthcareMagic,
I have gone through your concerns.

Basically lichen planus is a clinical diagnosis and biopsy is usually not required.
If your doctors are sure about the diagnosis there is no need to go for a biopsy.

Moreover, steroids are the treatment of choice for lichen planus.

Also, Tacrolimus is an immunosuppressive drug and since you had a history of squamous cell carcinoma in the past you should not be using it for a long duration.

So I would recommend you to apply clobetasol propionate cream on the affected area twice daily 2 weeks and gradually taper it off.
If required you can use Tacrolimus later on.

Dr Asmeet

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