Lichen planus (LP) is a common inflammatory skin disorder of unknown origin. When generalized and relapsing, treatment of LP can be a challenge. We present a patient with widespread and relapsing generalized LP who was treated with efalizumab for 3 months. Both pruritus and the skin lesions responded promptly to this biologic. In accordance with the previously reported efficacy in oral erosive LP, efalizumab may be a promising novel future treatment option for patients with cutaneous LP.