Background: Oral lichen planus (OLP) is an inflammatory disease that is painful in its erosive and atrophic forms. Although steroids are the corner stone of treatment for this disease, they have many side effects especially with repeated administration of the drug. Low level laser therapy (LLLT) has been recently administrated as a new treatment modality for OLP. Aim: To evaluate the effect of low level laser therapy versus topical steroids before and after treatment in OLP patients as well as 2 months ( or after exacerbation). Materials and Methods: A case control study of 24 patients diagnosed as having OLP. Twelve patients received topical steroids, and 12 patients received LLLT. The level of TNF-alpha was assessed before and after treatment by means of biochemical analysis as well as 2 months (or after exacerbation). Results: In both groups, there was a statistically significant decrease in pain scores post-treatment. However, after treatment, the Corticosteroids group showed statistically significantly lower mean pain scores than Laser group (p= 0.02). In the laser group, statistically significant decrease in RAE post treatment (p = 0.035) was found, and corticosteroids group showed statistically significant lower mean RAE than Laser group (p= 0.02). The TNF-α levels post-treatment in the corticosteroids group were of higher significance (p = 0.008) than those of the laser group (p = 0.037).Conclusion: LLLT is as effective as topical steroids in reduction of high serum TNF-alpha levels.