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Lichen planus

What is Lichen planus?

Lichen planus is an inflammatory disease that usually affects the skin and mucous membranes resulting in inflammation, itching, and distinctive skin lesions. It may affect the genital skin as well. It is not an infectious disease, it does not appear to be inherited, and it is not related to nutrition.
What is the cause?

Lichen planus is a recurrent, itchy, inflammatory rash or lesion on the skin or in the mouth. The exact cause is unknown, but the disorder is likely to be related to an allergic or immune reaction. The disorder has been known to develop after exposure to potential allergens such as medications, dyes, and other chemical substances. Symptoms are increased with emotional stress, possibly because of changes in immune system during stress.

Lichen planus generally occurs at or after middle age. It is less common in children. The initial attack may last for weeks to months, resolve, then recur for years. Lichen planus may be associated with several other disorders, most notably hepatitis C. Chemicals or medications associated with development of lichen planus include gold (used to treat rheumatoid arthritis), antibiotics, arsenic, iodides, chloroquine, quinacrine, quinidine, antimony, phenothiazines, diuretics such as chlorothiazide, and many others.
What are the symptoms?
Itching in the lesion
-may be mild to severe
Skin lesion
-usually located on the inner areas of the wrist, legs, torso, or
genitals
-generalised
-symmetric appearance
-single lesion or clusters of lesions, often at sites of skin trauma
-papule 2 to 4 cm size
-papules clustered into a plaque or large, flat-topped lesion
-distinct, sharp borders to lesions
-possibly covered with fine white streaks or linear scratch marks
-shiny or scaly appearance
-possibility of developing blisters or ulcers
Ridges in the nails
Dry mouth
Metallic taste in the mouth
Mouth lesions
-tender or painful (mild cases may have no discomfort)
-located on the sides of the tongue or the inside of the cheek
-occasionally located on the gums
-poorly defined area of blue-white spots or "pimples"
-linear lesions forming a lacy-appearing network of lesions
-gradual increase in size of affected area
-lesions occasionally erode to form painful ulcers
Hair loss

How is the diagnosis made?

The doctor suspects lichen planus based on the distinctive appearance of the lesions. A skin lesion biopsy or biopsy of a mouth lesion can confirm the diagnosis.

What is the treatment?

The goal of treatment is to reduce the symptoms and speed healing of the skin lesions. If symptoms are mild, no treatment may be needed.

Treatments may include:

Antihistamines (anti-allergic medicines), If one has mouth lesions, lidocaine mouth washes may numb the area temporarily and make eating more comfortable
Topical corticosteroids (such as triamcinolone acetonide cream) or oral corticosteroids (such as prednisone) may be prescribed to reduce inflammation and suppress immune responses. Corticosteroids may be injected directly into a lesion
Topical retinoic acid cream (a form of vitamin A) and other ointments or creams may reduce itching and inflammation and may aid healing
Occlusive dressings may be placed over topical medications to protect the skin from scratching
Ultraviolet light therapy may be beneficial in some cases

What is the prognosis?

Lichen planus is generally not harmful and may resolve with treatment, but can persist for months to years. Oral lichen planus usually clears within 18 months.

What are the complication?

Patients with oral lichen planus (mouth ulcers) may be at a slightly increased risk of developing oral cancer. Because of this increased risk, dermatologists recommend discontinuing the use of alcohol and tobacco products, which also increase the risk.
Regular visits to the dermatologist, every six to twelve months - for oral cancer screening are also recommended.

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