Sequential Use of Apremilast, Total Glucosides of Paeony, and Periodontal Therapy in Refractory Plurimucosal Lichen Planus: A Case Report.

Lichen planus (LP) is a chronic inflammatory disorder affecting mucosa and skin. This report presents a 61-year-old female with refractory LP involving buccal, gingival, and vulvovaginal mucosa, unresponsive to prior therapies including corticosteroids and hydroxychloroquine. The patient was treated with apremilast, a phosphodiesterase-4 inhibitor, combined with total glucosides of paeony. Within 4 weeks with apremilast and total glucosides of paeony, the patient experienced significant clinical improvement, with reduced Investigator Global Assessment and reticulation-erythema-ulceration scores. Periodontal scaling and root planing were performed at 8 weeks, further enhancing oral health. At 14 and 20 months after treatment initiation, the patient's condition remained stable, with no significant adverse effects. This case suggests that sequential therapy with apremilast and total glucosides of paeony may be a promising option for managing refractory LP involving multiple mucosal sites. Strategically timed periodontal intervention, initiated after systemic control, improved tolerability and underscored the value of a sequential, multidisciplinary approach.