What is Lichen Planus?

Lichen planus is a rare skin condition that is a result of an autoimmune system. But what triggers immune system is not clear. It is a skin rash sometimes with blisters. It can appear in any part of the body. It can appear inside the mouth also. It can appear in the scalp and genitals also. It is not contagious; that means you cannot get it from others. No treatment can cure lichen planus completely, but some medications and procedures can control its symptoms.

Symptoms of Lichen Planus

Symptoms of lichen planus depending on the areas it affects. It appears on different parts of the body.

Symptoms appearing on your skin

  • A rash appears on your skin suddenly, and may last for several months.
  • Purplish, flat-topped bumps appearing on your inner forearm, wrist or ankle.
  • Itching
  • Sometimes, white streaks may appear on the papules, called Wickham’s striae.
  • Papules may be 3mm to 5mm in diameter.
  • Blisters may burst to form scabs or crusts.
  • Lichen planus affect areas such as wrists, elbows, ankles and lower back. However, It may appear on other parts of the other parts of the body.
  • Hypertrophic (thickened) lichen planus usually appears on shins(front lower part of the knees) whereas annular (ring-shaped) lichen planus appear on armpits.

Symptoms of oral lichen planus (appearing in the mouth):

  • White patches form on the inside of the cheeks, the gums, tongue, and lips.
  • These patches may not be painful or itchy.
  • The white spots are recurrent.
  • Blisters may develop on the gums.
  • Redness of the gums.
  • Sore mouth ulcers may develop and recur.
  • Your sense of taste may become blunted.
  • Dryness of mouth.
  • Spicy foods, crispy foods or tomato products may aggravate the condition.

Symptoms appearing on the penis

  • Purplish or whitish ring-shaped patches may appear around the head of the penis (glans).
    Usually not itchy.
  • Symptoms are similar to thrush, like redness, swelling and thick white discharge on the top of the penis.

Symptoms appearing on the vagina and vulva:

Symptoms on Vulva

  • White streaks develop on the vulva, similar to those that appear in the mouth.
  • Generally not itchy or painful
  • Mucous membrane becomes red and raw.
  • The skin may become red.
  • Inner lips (labia minora) and the opening to the vagina (introitus) may become affected.

Symptoms on Vagina

  • The vagina may become red.
  • Scar tissue that develops after the damage of the normal tissue may deform the vaginal shape.
  • It may affect deeper within the vagina may lead to desquamative vaginitis.
  • A filthy discharge appears when the vaginal surface cells are stripped off.
  • The erosion of vagina may cause bleeding when touched, and sexual intercourse may become painful.

Lichen planus appearing on hair follicles and scalp (Lichen planus follicaris and lichen planopilaris respectively)

  • It affects hairy areas, such as the scalp.
  • Redness and irritation on the scalp.
  • Discoloration of the scalp.
  • Hair loss which may be permanent.

Symptoms appearing in other areas – Lichen planus affecting these areas are extremely rare. These areas are:

  • Nails – Damage or loss of nails
  • Anus
  • Ear canal
  • Eyelids
  • Esophagus

Causes and risk factors of Lichen Planus

Lichen planus is a result of the autoimmune system. It happens when your immune system mistakenly attacks your skin cells or mucous membrane. But what is the exact cause of this, is not known. Lichen planus can affect anyone at any age. Lichen planus is common in middle-aged people and rarely affects children and older people. There are some factors which can increase the risk of developing lichen planus. These risk factors are:

  1. Family history – Close family member who has lichen planus.
  2. Viral infection like Hepatitis C
  3. Flu vaccine
  4. Exposure to allergens. Certain chemicals that act as allergens are:
  • antibiotics
  • arsenic
  • metals such as gold
  • iodide compounds
  • diuretics
  • certain kinds of dyes
  • Certain pigments
  • Medications such as Nonsteroidal anti-inflammatory drugs (NSAIDs). It includes naproxen (Aleve, others) and ibuprofen (Advil, Motrin IB, others).
  • Certain medications for heart disease, high blood pressure or arthritis.

Diagnosis of Lichen Planus

Your doctor or dermatologist can diagnose lichen planus by looking at your rashes. To confirm the condition, you may be suggested for a skin biopsy. Your doctor or dermatologist will take a small sample of your skin cells and view them under a microscope. If lichen planus is suspected to be because of allergens, then you may be suggested for an allergic test, and if the underlying cause is an infection, then you may be recommended for a test for hepatitis C.

Treatment of Lichen Planus

Lichen planus has no cure. Treatment of lichen planus involves relief from its symptoms. First-line treatment includes corticosteroids and avoidance of factors that triggers the condition. Skin lesions may go away without treatment also in 6-9 months. Some pursue treatment for a cosmetic reason.

Treatment for cutaneous lichen planus (lichen planus of skin)

Avoiding allergens that trigger your condition can give you relief from the symptoms. Some topical creams and pills can be helpful.

  • Topical corticosteroids – It is available in cream or ointment can reduce swelling and redness.
  • Antihistamines – Antihistamine pills help relieve itching.
  • Corticosteroid pills such as prednisone can be helpful when the lesions are many and painful and lasts for longer time.
  • Light therapy –  Narrow band UVB phototherapy or systemic PUVA therapy can help clear the skin.
  • Retinoids such as Acitretin, or sulfasalazine – Can be present in cream or can be available as a pill. Both are effective.
  • Tacrolimus ointment or pimecrolimus cream – If it is associated with other skin problem like eczema, then is can be used to treat eczema.

Treatment of oral lichen planus

Mild oral lichen planus gets healed on its own over time by improving oral hygiene. For severe cases of oral lichen planus, treatment includes:

  • Using mouthwash that contains an anesthetic to numb temporarily the mouth, which eases eating.
  • Topical corticosteroids such as dexamethasone, betamethasone, clobetasol, and analgesics and triamcinolone give relief from swollen gums and pain.
  • Corticosteroid sprays, pastes, and dissolvable tablets,
  • Using mouthwash that contains an antiseptic to help prevent the plaque formation in your mouth.
  • Calcineurin inhibitors such as pimecrolimus, tacrolimus or cyclosporin are also sometimes recommended.
Lichen Planus Can Affect Your Different Parts of The Body

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