Lichen planus is an inflammatory skin condition that is distinguished on the arms and legs by itchy, non-infectious rash. It is made up of small, multi-sided, white, pink or purple bumps.
A large number of skin specialists say it could be an autoimmune disease.
Lichen planus affects about 1 percent of Americans, according to the American Skin Association. Typically it occurs in people over 30 years of age.
Fast facts on lichen planus
Here are some key points about lichen planus.
- Lichen planus is a non-infectious, inflammatory skin disorder.
- The exact causes of lichen planus are not yet understood.
- The condition is estimated to affect 1 percent of the population.
- People with hepatitis C are more susceptible to lichen planus.
- Treatment for lichen planus may include antihistamines, phototherapy, or steroid creams.
Treatment
The lichen planus is not a curable disease.
It usually clears up by itself within several months when it affects the skin. That can take up to 2 years, however. Care should concentrate on relieving symptoms until the rash clears.
Moderate cases do not need medical care, except for periodic checkups.
Treatment for serious lichen planus cases might include:
- Antihistamines may be used to reduce itching.
- Phototherapy with ultraviolet (UV) light can also be used to reduce symptoms.
- Steroid creams or ointments can be very effective in reducing inflammation and redness. The medication is applied to the itchy spots. Treatment should stop when the spots change color to brown or gray.
- Sometimes, creams or ointments may contain drugs that reduce the immune response.
- For people with more severe symptoms, or when creams and ointments are not effective enough, steroid tablets can be taken orally.
- Cyclosporin capsules or acitretin tablets can reduce the activity of the immune system and may sometimes help. They are only used in extremely severe cases.
- For lichen planus that occurs in the mouth, the doctor may prescribe steroid lozenges or mouthwashes if mouth ulcer symptoms become uncomfortable.
- For lichen planus of the mucous membranes, treatment can be difficult to get right and may take years. The doctor may prescribe corticosteroids to be taken as tablets.
Luckily, the planus of oral lichen causes few complications and typically does not require treatment. Oral hygiene in people with oral pain can be poor, which makes maintaining good oral hygiene even more important .
Diagnosis
A doctor may be able to diagnose lichen planus based on its appearance, after inspecting the skin and recognizing the characteristic rash.
In some cases, a doctor may need to do a punch biopsy, where a circular instrument removes a small sample from the deeper layers of the skin. Stitches are often required to close the wound. To confirm a diagnosis of lichen planus, the sample is examined under a microscope.
If the doctor is still unsure, a dermatologist, or skin specialist, will refer the patient.
A dentist or oral specialist will usually arrive at a diagnosis after taking a biopsy for a person with oral lichen planus.
Symptoms
For weeks, and even months, the first attack can continue, while recurrences can last for years. For oral lichen planus cases recurrences are more likely.
Symptoms take the form that occurs when they occur in certain places.
Lichen planus of the skin
- The rash appears abruptly and usually lasts for several months.
- There are clumps or patterns of shiny, raised, red, pink, or purple, flat-topped bumps.
- Papules are approximately 3 to 5 millimeters (mm) in diameter.
- White streaks may sometimes appear on the papules, called Wickham’s striae.
- Intense itching may occur, especially at night.
The most affected areas are the lower back, knees, elbows, ankles and. Other parts of the body, however, may be affected. The shins may be affected by thickened lichen planus, whereas the armpits may have lichen planus in ring-shaped form.
Oral lichen planus
- White streaks appear on the inside of the cheeks. The gums, tongue, and lips may also be affected.
- The streaks are not usually painful or itchy.
- The white streaks do not go away.
- Possible redness and blistering of the gums.
- Sore mouth ulcers can develop and recur.
- The individual’s sense of taste may become blunted, and some people experience a metallic taste.
- The individual can have a dry mouth.
- Spicy foods, crispy foods, and tomato products can make symptoms worse.
Lichen planus of the penis
- Purple or white ring-shaped patches appear around the head of the penis.
- They are not usually itchy.
- Symptoms are similar to thrush, and often mistaken for it.
Lichen planus of the vagina and vulva
White streaks form on the vulva, close to those in the mouth. In general, they’re neither itchy nor painful.
The skin could be dark. Lichen planus on the inner lips, or labia minora, and the vagina entrance can continue to return, with bright red and raw mucous membrane affected. Sometimes, the labia minora may shrink and cling to one another or the outer lips, sometimes known as the majora labia.
The vagina is probably purple. Scar tissue can distort vaginal shape. Lichen planus can affect deeper areas of the vagina, which can lead to desquamative vaginitis. Discharge can occur when vaginal surface cells peel off. If rubbed the damaged vagina would easily bleed.
Sexual intercourse can become painful, difficult or impossible.
Lichen planus follicaris
This affects places where hair, for example the scalp, develops. Redness, and frustration may occur. Often, this form of lichen planus causes hair loss which can be permanent.
The lichen planus can occur in anus, ear canal, eyelids, and esophagus in extremely rare cases.
Causes
It is unclear what exactly causes lichen planus.
Some say it is an autoimmune disorder, where healthy tissues are mistakenly targeted by the immune system.
Of the lichen planus, the following is known:
- It does not appear to be a hereditary condition.
- It is not an infectious condition
- It is not a form of cancer.
- It is not linked to nutrition. However, spicy foods, citrus juices, and tomato products may aggravate symptoms if there are open sores in the mouth.
Some causes of lichen planus are thought to involve the following:
Medications: Lichen planus can occur as a reaction to certain medicines, including:
- beta-blockers, which are common drugs used to treat cardiovascular problems
- anti-inflammatory medications
- gold injections for the treatment of arthritis
- antimalarials
- thiazide diuretics
- phenothiazines, a group of tranquilizing drugs with antipsychotic actions
Other substances: There is a link between contact with some chemicals used in color photographic development and lichen planus.
Mercury tooth fillings: Some studies have found a link between lichen-planus-type changes in the mouth and an allergic reaction to mercury tooth fillings.
Lichen planus can also be part of Grinspan’s syndrome, a syndrome characterized by hypertension, diabetes, and oral lichen planus.
Home remedies
While lichen can not be cured, some home remedies have been reported to relieve symptoms.
Turmeric was suggested as a treatment for oral lichen planus as it had immune system activity that could help reduce the inflammation leading to the disease.
A recent pilot study has shown promising results for the treatment of this herb.
Other recommended treatments include:
- applying certain oats, such as Avena sativa, to the skin
- chewing sage
- applying aloe vera gels to the skin
- essential oils
- borax
However, there appears to be little to no evidence supporting the safety and effectiveness of these treatments.
It is better to follow a course of treatment prescribed by a medical professional.
Risk factors
Lichen planus can affect humans of any age or race.
However, it is more common among:
- middle-aged adults
- females, especially oral lichen planus
- patients with liver diseases, such as hepatitis C or cirrhosis
Complications
Once the rash is gone, permanent brown or gray marks can appear on the skin. On darker skin, those will be more visible.
In rare cases chronic skin lesions and mouth ulcers may increase a small amount of the risk of developing cancer.
