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Lichen Planus

What is lichen planus?

Lichen planus is a relatively common inflammatory disease that affects the skin and/or inside the mouth, resulting in distinctive skin and/or oral lesions. Lichen planus of the skin usually causes itching. There seems to be a relationship between the oral form and the skin form of lichen planus. Almost half of those with the oral version also have skin lesions. The onset may be gradual or quick, but the exact cause of the inflammation that leads to lichen planus is not yet fully understood. It is important to note that lichen planus itself is not an infectious disease. Therefore, this disease is not passed from one person to another by any means. Lichen planus is not a type of cancer.

Who gets lichen planus?

Lichen planus affects around one percent of the general population. Both men and women can get lichen planus. Skin lichen planus affects men and women equally, but oral lichen planus affects women twice as often as men. Although it may occur at any age, it usually affects middle-aged adults. It is uncommon in the very young and elderly. This disease can affect any individual all over the world, regardless of the race, skin color and culture.

What are the signs and symptoms of lichen planus?

Lichen planus of the skin appears as small, flat-topped, red-to-purple bumps with round or irregular shape. You may have just a few small bumps or you may have many. If you take a closer look, you might see white scales or flakes on them. Some may have wispy, gray-to-white streaks called Wickham's Striae. Lichen planus causes itching with an intensity that varies in different people from mild to severe. Sometimes the bumps don't itch, but typically they do. Lichen planus can appear on any area of the skin. The most common areas are the inner wrists, the forearms and the ankles. It may also affect the scalp?or the nails. On the scalp, it may cause redness, irritation, and, in some cases, hair loss. Sometimes this disease affects the areas of skin where you had a trauma, such as a superficial scratch, cut, or burn. Lichen planus of the nails can cause brittle or split nails, and the affected nails may have ridges running lengthwise. In the mouth, lichen planus looks like lacy white patches on the inside of the cheeks or on the tongue. Oral lesions do not usually cause symptoms, though severe outbreaks may cause painful sores and ulcers that make it hard to eat and drink. Lichen planus can affect the female genitals, including the vagina. In the vulva or vagina, it may appear as bright red patches or sores. Such condition can be confused with sexually transmitted diseases, although lichen planus is neither sexually transmitted nor contagious as mentioned above. Genital lichen planus does not usually cause symptoms, but open sores may be quite tender.

What cause lichen planus?

In most cases, the cause of lichen planus can't be found. It is not caused by stress, but sometimes emotional stress makes it worse. This disorder has been known to occur after contact with certain chemicals, such as those used to develop color photographs. Some cases of lichen planus may be linked to chronic hepatitis C virus infection. This virus can cause serious liver diseases, such as liver cirrhosis and liver cancer. Your doctor may need to order a blood test to check for hepatitis C virus. In some people, certain drugs cause lichen planus. These drugs include medications for high blood pressure, heart disease, diabetes, arthritis and malaria, antibiotics, non-steroidal anti-inflammatory pain killers, etc. It is important to tell your doctor all the medicines you are taking. The rashes will go away after the offending drug is stopped. People who have lichen planus in the mouth may be allergic to certain products used during dental procedures, such as amalgam fillings. Patch testing may be used to specify the allergy; removal of dental material is recommended and may result in cure.

How is lichen planus diagnosed?

The diagnosis of lichen planus is often made by a dermatologist, oral surgeon or dentist on the basis of the typical clinical appearance. A skin biopsy may be needed to confirm the diagnosis. In case of oral lichen planus, your physician may have to make sure that the lesions are not caused by yeast, and a biopsy is often recommended to confirm or make the diagnosis and to rule out other oral diseases including cancer (see below). For a biopsy, a small bit of skin or mucosa is taken from the lesion. It is sent to a laboratory to see if it is actually lichen planus by microscope.

How is lichen planus treated?

Most of the time, the bumps go away without any treatment after about a year. However, treatment can make your skin look better. The goal of treatment is to reduce your symptoms and speed healing of the skin lesions. If symptoms are mild, no treatment may be needed. There is no known cure for skin lichen planus, but treatment is often effective in relieving itching and improving the appearance of the rash until it goes away. Lichen planus of the scalp must be treated right away, or the hair of the affected area may never grow back. Since every case of lichen planus is different, no one treatment does the job. Topical corticosteroids are very useful. You can use a corticosteroid ointment or cream that you apply directly to the bumps. Corticosteroids may be injected directly into a lesion. In the mouth, steroid pastes or inhalant powders may be easier to apply to affected sites. Hydrocortisone foam can be used inside the vagina. Antihistamines may be prescribed to relieve itching. Extensive cases may require the use of oral corticosteroid for a few weeks or longer. This usually shortens the duration of the outbreak, but may have serious side effects. Ultraviolet light therapy (also called PUVA) may be beneficial in some cases. The so-called immune modulating drugs, tacrolimus ointment and pimecrolimus cream, may be useful for oral and genital lichen planus. Other treatment options include topical or oral retinoid (a form of vitamin A), long term antibiotics, oral antifungal agents, phototherapy, methotrexate, hydroxychloroquine, etc.

What is the long-term outlook for lichen planus?

In general, lichen planus is not a harmful or fatal disease. It usually goes away by itself in time, but can persist for a long time, running into years, and this varies from patient to patient. The presence of skin lesions is not constant and may wax and wane over time. Oral lesions tend to last longer than those of the skin. Furthermore, even after going away completely, lichen planus may recur. As it heals, lichen planus often leaves a dark brown discoloration of the skin. Like the bumps themselves, these stains may eventually fade with time without treatment. When oral mucosa is affected by lichen planus, there is a slightly increased risk of developing oral cancer. If oral lichen planus is present, you should avoid the use of alcohol and tobacco products, which also increase the risk. Regular visits to the dermatologist or dentist — at least twice a year — for an oral cancer screening is recommended.

More information

Did you know lichen planus affects not only skin but also oral mucosa?

Lichen planus is a long standing, itchy skin disease of unknown cause. It frequently affects the inside of the mouth as well. If it occurs in the mouth, the membranes appear gray and lacy. In addition, it can affect other parts of the body, such as the nails, scalp, vulva, vagina and penis.

Did you know lichin planus is not a harmful disease?

Although lichen planus is a disease of uncertain cause and is difficult to be cured by treatment, this skin disease itself is neither life threatening like cancer nor infectious. Therefore, lichen planus is very unlikely to affect your general health and cannot be passed on. Most cases of lichen planus disappear even without treatment in the long course of time.

Did you know some cases of lichen planus may be reaction to particular medicine?

In some people, certain drugs may cause lichen planus. These include widely-prescribed drugs such as medications for high blood pressure. Thus, it is important to tell your doctor all the medicines you are taking.

Did you know some cases of lichen planus may be linked to hepatitis C virus infection?

Lichen planus has been reported as a complication of chronic hepatitis C virus infection. This virus can cause serious liver disease. Your doctor may need to order a blood test to check for hepatitis C virus.