Objective: This study aimed to assess the clinical efficiency of Narrow Band-Ultraviolet B (NB-UVB) phototherapy and methotrexate (MTX) therapy and their effects on serum tumor necrosis factor-alpha (TNF-α) in patients with cutaneous lichen planus (CLP). Methods: The present cohort study was carried out on 60 patients with CLP who attended the Out-patient Clinics of the Dermatology, Department, Faculty of Medicine, Faculty of Medicine, South Valley University between May 2018 and December 2019.The included patients were indiscriminately classified into two treatment groups; group A (30 patients), received NB-UVB phototherapy for three months and group B (30 patients), received MTX therapy for three months. All the patients were assessed clinically and TNF-α before and after treatments. Results: There were no statistically significant differences between the two groups of treatment regard clinical improvement after treatment (P=0.149). Regarding levels of TNF-α, there was a statistically significant difference between the two treatment groups after treatment (P=0.024). There was a statistically significant reduction in TNF-α level after treatment in the MTX group. Conclusion: This study concluded that NB-UVB phototherapy and MTX therapy were clinically effective in the treatment of patients with CLP. MTX therapy was more efficient in the reduction of TNF-α level than NB-UVB phototherapy in patients with CLP.