Lichen planus is a non-infectious, non- contagious inflammatory skin disorder that can affect the skin, hair, nails and mucous membranes of the mouth and vagina.

Causes:

  • It is thought to be autoimmune disease (where the body’s immune system targets its own tissues)
  • However, doctors are not sure why this happens.
  • Lichen planus can occur at any age.
  • Lichen planus on skin occurs in men and women equally, but women are twice as likely to get the oral form. It’s very rare in children and older adults. It’s most common in middle-aged people.


Other causes could be

  • Family members who’ve had lichen planus.
  • Having a viral disease like hepatitis C
  • Being exposed to certain chemicals, metals and pigments that act as allergens. These allergens may include:
              Arsenic, Gold, Iodide compounds, Certain dyes
  • Medications that are used for heart disease, high blood pressure or arthritis

    Symptoms:

Symptoms take the following forms when appearing in certain areas in the body.

Lichen planus of the skin:
On the skin, lichen planus usually appears as purplish, raised, shiny flat-topped lesions called papules.

Papules are approximately 3 to 5 millimeters in diameter.
Intense itching may occur, especially at night.
White streak lines may sometimes appear on the papules, called Wickham’s striae.

Most affected areas are the wrists, inner forearm, elbows, ankles and lower back. However, other parts of the body may also be affected.


Oral lichen planus

White streaks lacy patches appear inside the mouth involving the gums, tongue, and lips may also be affected
Sometimes painful sores may also be seen.
The oral rash often occurs prior to that of skin involvement.

Sore mouth ulcers can develop and recur.

Sense of taste becomes blunted, and some people experience a metallic taste.
Dry mouth can be another symptom.

Spicy foods, citrus and tomato products can make symptoms worse.

On scalp

Lichen planus may involve the scalp, producing permanent, scarring type of balding.

Lichen planus of the vagina and vulva

On the vulva, white streaks develop, similar to those that of in the mouth. Unlike oral lesions they are usually neither itchy nor painful.

Lichen planus on labia minora may keep recurring.

Also affect deeper areas within the vagina, causing desquamative vaginitis. Discharge can even 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 on nails:

Nail damage or nail loss can be seen.

Diagnosis:
Physicians can make the diagnosis in typical cases simply by looking at the rash. If necessary, a skin biopsy may be done 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 the diagnosis of lichen planus.

Treatment:

Lichen planus is not a curable condition, however it is self limiting in many cases.

When it affects the skin, it usually takes several months to clear by itself.

However, it can take up to 2 years. Treatment focuses on to lessen symptoms until the rash clears.

  • retinoids, which are vitamin A and are supposed to be taken topically or orally

  • corticosteroids reduce inflammation and can be taken topical, oral, or given as an injection too.
  • Antihistamines that reduces inflammation and rash

  • nonsteroidal creams are applied topically can suppress your immune system and help clear up the rash

  • light therapy treats lichen planus with ultraviolet light

Tips to overcome rash:

  1. Avoid scratching
  2. Applying cool compresses to the rash
  3. Using OTC anti-itch creams
  4. Avoiding hot water bath

For oral lichen planus

  1. Stay away from chewing tobacco, alcohol intake and smoking.
  2. Stop consuming irritant foods like spicy foods.
  3. Visit your Dentist frequently.

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. You may consult your dermatologists.

-Dr krishna Priya


References:
https://rarediseases.org/rare-diseases/lichen-planus/

https://www.webmd.com/oral-health/oral-lichen-planus#1


 

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