Lichen planus: Causes, symptoms, and treatments

Lichen planus is an inflammatory skin condition, characterized by an itchy, non-infectious rash on the arms and legs. It consists of small, many-sided, flat-topped, pink or purple bumps.

A significant number of skin specialists believe it might be an autoimmune disease.

According to the American Skin Association, lichen planus affects around 1 percent of Americans. It typically occurs in people over the age of 30 years.

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


Antihistamines may be used to treat itching in severe cases of lichen planus.

Lichen planus is not a curable condition.

When it affects the skin, it usually clears by itself within several months. However, it can take up to 2 years. Treatment focuses on easing symptoms until the rash clears.

Mild cases require no treatment by the doctor, except for occasional checkups.

Treatment for severe cases of lichen planus may include the following:

  • Antihistamines may be used to reduce itching and are available for purchase online.
  • 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.

Fortunately, oral lichen planus causes few problems and treatment is not usually required. Oral hygiene can be poor among people with oral pain, which makes it even more important to maintain good oral hygiene.

Diagnosis

After examining the skin and identifying the characteristic rash, a doctor may be able to diagnose lichen planus based on its appearance.

In some cases, a doctor may need to perform a punch biopsy, in which a circular tool extracts a small sample of the skin’s deeper layers. Often, stitches are required to close the wound. The sample is examined under a microscope to confirm a diagnosis of lichen planus.

If the doctor is still unsure, the patient may be referred to a dermatologist, or skin specialist.

For a person with oral lichen planus, a dentist or oral specialist will usually reach a diagnosis by taking a biopsy.

Symptoms


The rash appears abruptly and usually lasts several months.

Symptoms vary depending on the site of the condition.

The first attack can continue for weeks, and even months, while recurrences can go on for years. Recurrences are more common in cases of oral lichen planus.

Symptoms take the following forms when appearing in certain areas.

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.

Most affected areas are the wrists, elbows, ankles, and lower back. However, other parts of the body may be affected. The shins can be affected by thickened lichen planus, while the armpits might have ring-shaped lichen planus.

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

On the vulva, white streaks develop, similar to those that appear in the mouth. They are usually neither itchy nor painful.

The skin may be red. Lichen planus on the inner lips, or labia minora, and the entrance to the vagina may keep returning, and the affected mucous membrane is bright red and raw. The labia minora may also shrink and stick to each other or the outer lips, also known as the labia majora.

The vagina may be red. Scar tissue may distort the shape of the vagina. Lichen planus can affect deeper areas within the vagina, causing desquamative vaginitis. Discharge can occur when the surface cells in the vagina peel off. The eroded vagina may easily bleed when touched.

Sexual intercourse may become painful, difficult, or impossible.

Lichen planus follicaris

This affects areas in which hair grows, such as the scalp. There may be redness and irritation. This type of lichen planus sometimes causes hair loss, which can be permanent.

In extremely rare cases, lichen planus can occur in the anus, ear canal, eyelids, and esophagus.

Causes


The exact causes of lichen planus are still not known.

The exact cause of lichen planus is unclear.

Many believe it is an autoimmune disorder, where the immune system mistakenly attacks healthy tissues.

The following is known about lichen planus:

  • 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 cannot be cured, some home remedies have been said to relieve symptoms.

        Turmeric has been suggested as a remedy for oral lichen planus as it has shown effects on the immune system that could help reduce the inflammation that contributes to the condition.

        A recent pilot study demonstrated promising results for this herbal treatment.

        Other suggested 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

        After the rash has gone, there may be permanent brown or gray marks on the skin. These will be more noticeable on darker skin.

        In rare cases, persistent skin lesions and mouth ulcers may increase the risk of developing cancer by a small amount.

        Source: Lichen planus: Causes, symptoms, and treatments

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