Background: The erosive-atrophic form of oral lichen planus (OLP) is usually presented with severe pain and burning sensation that is usually refractory to traditional treatment. Topical corticosteroid is considered the first line despite their adverse effects. Therefore, new therapeutic approaches are required. Aim: This study aimed to examine the effectiveness of Nd:YAG laser in the treatment of long-standing erosive-atrophic OLP. Patients and methods: Twenty-four patients diagnosed with OLP were included in this study. A total of 59 lesions was assessed as regards to the degree of pain by visual analog scale and clinical scores by Thongprasom sign scoring system before and after treatment. All patients were treated by Nd:YAG laser therapy with (1064 nm 0.5 W, 30 s, 1.2 J/cm2) three times weekly and for 1 month. Treatment efficacy index was determined after the end of therapy. Results: A significant pain reduction was detected after Nd:YAG laser treatment (p < .0001). In addition to that, complete resolution was achieved in about 37.3% of the lesions and improvement in clinical signs was found in 59.3% of the lesions. By the end of therapy, about 30.5% showed score 1 while 11.9% of them were scored 3. Also, 8.5% of the lesion was scored 2, 6.8% were scored 4 and 5.1% were scored 5. Actually, all of the participating patients showed some degree of improvement and most of them achieved moderate recovery. Conclusion: The results of this study can indicate that Nd:YAG laser is an effective modality that can be used safely in the management of erosive-atrophic OLP.