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Lichen planus is a condition characterized by inflammation of the skin, hair, nails, mouth, and genitals. Skin manifestations typically present as itchy, flat, purple bumps that emerge gradually over a few weeks. In the oral and genital mucosa, lichen planus manifests as lacy white patches, occasionally accompanied by painful sores.
In many cases, it spontaneously resolves without intervention, but in some cases, treatment is necessary to relieve associated symptoms, including itchiness.
Symptoms
Lichen planus symptoms differ according on the body area afflicted. While lichen planus itself is not painful, scratching the rash can lead to skin breakage, increasing the risk of infection and subsequent discomfort.
Common symptoms include:
- Small, raised dots may appear on the skin, including the genital area, starting at the size of a pin tip, and potentially expanding to the width of a pencil. These dots might progress into sores over time.
- Shiny, flat, purple lumps, usually on the wrists, ankles, or inner forearms.
- Rashes along the lines where skin has been scratched.
- Changes in the color, cracking, splitting, stop growing, or loss of nails may occur.
- Tiny white dots may emerge on the inner skin of the cheeks, tongue, or lips.
- Genital or oral sores that cause pain.
- Hair loss, in rare cases.
- Itchiness.
Medical attention is necessary if there are unexplained tiny bumps or a rash on the skin or experience symptoms related to lichen planus in the mouth, genitals, scalp, or nails. Or if one notices that the rash endures longer than anticipated, or observe signs of infection such as red, purple, gray, or white skin with irritation and swelling.
If any of the signs and symptoms persist, consult a healthcare provider for proper diagnosis and treatment. Seeking a timely and accurate diagnosis is crucial as various skin and mucous membrane conditions can lead to sores and pain.
Causes
Although the definite cause of lichen planus remains unknown, it is linked to the immune system targeting skin or mucous membrane cells. If a person experience a flare-up of lichen planus, it may be related to one or more of factors.
Lichen planus can be triggered by various factors, including hepatitis C infection, vaccines, nonsteroidal anti-inflammatory drugs (NSAIDs), specific medications used for arthritis, heart disease, or high blood pressure, as well as exposure to certain chemicals, metals, or pigments.
Risk factors
Lichen planus can affect anyone. However, studies indicate that women may experience lichen planus twice as frequently as men. If lichen planus manifests on the skin, there is a 50% to 75% increased likelihood of its presence in the oral cavity as well. Individuals between 30 and 60 years old are also more susceptible.
Diagnosis
The diagnosis of lichen planus involves a comprehensive examination of symptoms and a physical assessment. Some tests may be necessary to confirm the diagnosis.
The diagnostic process often involves identifying specific features referred to as the “six Ps”: pruritic (itchy), polygonal (with numerous sharp angles), planar (having a flat top), purple papules (bumps), and plaques (raised, discolored patches).
Tests that may be required include:
- Blood tests: This test is generally conducted to screen for health issues associated with lichen planus. Lichen planus is occasionally linked to the hepatitis C virus.
- Biopsy: A small sample of affected tissue is taken, using a thin blade (scalpel) or a punch tool, for laboratory analysis to check for characteristic cell patterns indicative of lichen planus.
- Allergy test: This can determine whether an allergy is responsible for the occurrence of the lichen planus flare-up.
Treatment
Lichen planus does not have a cure. Mild cases in the skin typically resolves on its own without treatment, ranging from a few months to several years. If it is not accompanied by pain or discomfort medications are not recommended. However, if itching, pain, or healing speed are concerns, medications and treatments are available. Multiple approaches may be necessary to manage symptoms.
If the lichen planus is in the mouth, it typically resolves within five years. To alleviate symptoms like irritation or sores, it is recommended to practice good oral hygiene, minimize mouth injuries, and replace dental fillings.
In some cases, treatment may be more challenging if the disease affects mucous membranes and nails, and even if successful, symptoms could reoccur.
Treatment options for lichen planus include:
- Corticosteroids: Topical corticosteroid may be initially recommended to treat lichen planus. Prescribed corticosteroid cream or ointment can alleviate pain, swelling, and inflammation.
If a topical corticosteroid proves ineffective, and the condition is severe or widespread, corticosteroid pills or injections may be prescribed. When used as directed, corticosteroids are generally considered safe.
- Oral medications: Antimalarial drug hydroxychloroquine and the antibiotic metronidazole are anti-infection drugs that can be used as treatment for lichen planus.
- Antihistamines: Antihistamines are frequently employed to alleviate allergy symptoms, including itchy skin.
- Phototherapy: This utilizes specific lamps to expose the skin to ultraviolet B (UVB) light, harnessing the beneficial effects of sunlight to address various skin conditions, including lichen planus. Also known as light therapy, done 2 to 3 times a week for a few weeks, this treatment can be effective in resolving skin lichen planus.
- Immune response medicines: Drugs, such as cyclosporine, azathioprine, methotrexate, mycophenolate, sulfasalazine, and thalidomide, have demonstrated some success in treating lichen planus, but further research is necessary. These medications modify the body’s immune response, are prescribe in cases of more severe symptoms.
- Retinoids (vitamin A derivatives): Retinoids, available in both pill and ointment forms, promote increased collagen and blood vessel production in the body, potentially improving the rash. However, retinoids are not recommended for pregnant individuals or those planning pregnancy as using retinoids can lead to birth defects.
- Dealing with triggers: Addressing triggers is essential in managing lichen planus symptoms. Adjustments to medications or additional allergen testing could be suggested to manage the condition effectively. This is often done when the lichen planus is suspected to be linked to factors like infection, allergies, or specific medications.
