Lichen Planus

What is Lichen Planus?

Lichen planus is an inflammatory disorder of the skin and mucous membranes with no known cause. It appears as itchy, purplish, flat-topped bumps and plaques, often with a lattice of fine white lines called Wickham striae.^[1]

Common symptoms

On the skin, lichen planus most often appears on the wrists, lower back and ankles and is itchy. In the mouth, it shows as white lacy lines on the inner cheeks and sometimes erosions or sores that burn or hurt.^{[1, 2]}

• Itchy purple bumps or plaques, which can leave darker skin afterward
• White lacy patches, redness or painful sores in the mouth
• Painful sores or redness in the genital area
• Nail thinning or ridging, and scalp involvement with hair loss^[3]

Causes and risk factors

The cause is unknown. The disease involves a T-cell driven inflammatory attack on the skin or mucosal lining, and the trigger is not known.^{[1, 2]} A lichen-like rash can also be caused by medicines, and it usually fades once the causative medicine is stopped under medical advice.^[1]

Lichen planus has been linked to other autoimmune conditions and to metabolic problems such as glucose intolerance and abnormal blood fats.^[3] Anxiety, depression and stress are much more common in people with oral lichen planus than in people without it, though that does not show which comes first.^[4]

How it is diagnosed and treated conventionally

A clinician usually diagnoses lichen planus from how it looks, and a biopsy may confirm it. It is important to be assessed by a physician, dermatologist or dentist, because other conditions can look similar.^{[1, 3]}

Most skin lesions clear on their own within 1 to 2 years, though recurrences are common. Oral lichen planus is chronic and may or may not remit, and symptoms often return after treatment.^[1] Strong topical corticosteroids are the first-line treatment for painful oral flares, with calcineurin inhibitors, retinoids and other immune-modulating drugs as later options.^[2]

Oral lichen planus carries a small risk of squamous cell carcinoma, about 1% of patients in one review, so regular follow-up matters.^[2] Newer treatments such as JAK inhibitors are being studied.^[3]

Why Lichen Planus calls for a whole-person approach

Lichen planus is driven by the immune system, but living with it involves more than skin or mouth lesions. Pain, itch, eating difficulty and visible lesions can lower quality of life, and a comprehensive approach that includes psychological support is recommended.^[3]

Supportive care aims at those parts of the experience and does not change the immune process itself.

Immune activity

Lichen planus is considered a T-cell mediated inflammatory disease.^[2] Medical treatment aims at this immune activity, which is why complementary care should not replace it.

Stress, anxiety and mood

A meta-analysis of 51 studies with 6,815 people found high rates of depression (about 31%), anxiety (about 55%) and stress (about 41%) in oral lichen planus, well above those in people without it.^[4]

Pain and eating

Erosive oral disease can be painful, with burning when eating spicy or acidic foods. Treatment trials focus on reducing this pain.^[5]

Related health conditions

Associated autoimmune, glucose and lipid problems are another reason to stay under regular medical follow-up.^[3]

Acupuncture as supportive care in Lichen Planus

What the research shows

We found no clinical trials of acupuncture for lichen planus. A systematic review of acupuncture in dermatology found 24 studies covering several skin conditions, and lichen planus was not among them.^[6] We therefore cannot say that acupuncture changes the course of lichen planus.

Acupuncture may still be considered for stress, sleep or general discomfort, but we found no lichen planus-specific trials of this either. Any benefit would be for those symptoms and not for the disease.

How acupuncture may work

No mechanism research specific to lichen planus was found. Researchers propose in general that acupuncture acts on the nervous system, but that has not been shown for this condition.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, with reassessment after a short course of visits. Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000.^[7] Tell the practitioner first if you have a bleeding disorder, take blood thinners or immunosuppressants, are pregnant, or have a pacemaker (relevant to electroacupuncture). Skin lesions sometimes appear at sites of skin injury, so tell us about any new rash after a visit.

Ayurvedic medicine as supportive care in Lichen Planus

The Ayurvedic view

Ayurveda groups itchy, inflamed skin conditions under Kushtha, a traditional category of skin disease, and describes them as disturbances of Pitta and Kapha with impaired digestion and the build up of ama. Lichen planus is sometimes matched to this category. These are traditional explanatory frameworks, not biomedical diagnoses.

Therapies that may be used

Care is individualized and traditionally may include:

• Diet and daily routine that avoid very spicy, sour or fermented foods and favor cooling, simple meals
• Stress-reducing practices such as breathing exercises and regular sleep
• Herbs and spices such as turmeric, prescribed individually
• Herbal preparations applied to the skin, including transdermal medication therapy, although no study supports benefit for lichen planus

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and oral sores need medical assessment first. Ayurvedic products also need careful sourcing: about one fifth of those bought online contained detectable lead, mercury or arsenic.^[8]

What the research shows

We found no trials of Ayurvedic treatment as a system for lichen planus. The only related research is on turmeric, a spice used in Ayurveda, and it is covered under herbal medicine below.^[9]

Herbal medicine as supportive care in Lichen Planus

Herbs and formulas that have been studied

Almost all herbal research covers oral lichen planus. Studied herbs include curcumin (from turmeric), aloe vera gel and total glucosides of paeony, a Chinese medicine extract.^{[10, 11]} Traditional Chinese medicine remedies for lichen planus have been described in reviews.^[12]

What the research shows

The evidence is limited and mixed. A systematic review of eight randomized trials of herbal interventions for oral lichen planus found that severity improved within groups, but only total glucosides of paeony beat steroids in between-group comparisons. The authors warned of high bias in the studies.^[10]

On curcumin, results disagree. A 7-week placebo-controlled trial was stopped early for futility.^[9] A small 20-person trial found larger improvements with high-dose curcuminoids than placebo, but its power was limited.^[13] A trial of 57 patients found nano-curcumin and prednisolone reduced pain and lesion size to a similar degree.^[14] A meta-analysis of curcumin across autoimmune diseases found that it did not show efficacy in oral lichen planus.^[15]

On aloe vera gel, one placebo-controlled trial of 54 people reported a good response in 81% of the aloe group versus 4% of the placebo group.^[16] Another of 64 people found no significant pain difference but better quality-of-life scores.^[17] A Cochrane review called the evidence for aloe vera weak.^[5] A 2022 systematic review of 70 trials listed aloe vera among treatments with some support, with topical steroids as the most cost-effective choice.^[11]

In an 81-patient trial, total glucosides of paeony added to corticosteroids lowered pain and lesion scores more than corticosteroids alone.^[18]

Safety and herb-drug interactions

Herbs can interact with medicines. Reviews describe enhanced anticoagulation and bleeding with warfarin and danshen, garlic or ginkgo, and lowered levels of ciclosporin and tacrolimus with St John's wort. Immunosuppressants are used in lichen planus, so tell us about every medicine.^[19]

Product quality matters too. About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[8] Tell us if you are pregnant or breastfeeding or have liver or kidney disease. Herbs should come from tested sources and be prescribed individually. Mouth products should never replace evaluation of a sore that does not heal.

Translating traditional medicine into modern biological language

These links are interpretation, not equivalence. Chinese medicine may describe itchy, red skin disease as damp-heat or blood heat, and a long-standing pattern as blood stasis or yin deficiency. Researchers would map such ideas to inflammation and T-cell activity, which are the focus of study in lichen planus.^[2]

Ayurveda's aggravated Pitta and ama describe heat, redness and a toxic build up. Curcumin, a turmeric compound, has been studied for its anti-inflammatory activity, but no study has shown that a pattern or dosha corresponds to a measurable biological process.^[9]

How this care fits with your medical care

Lichen planus needs medical diagnosis and treatment. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Keep your dermatologist, dentist or oral medicine specialist, continue prescribed steroids or other medicines, and do not stop or change them without your prescriber.

We do not diagnose lichen planus or manage the disease itself. Please bring your diagnosis, any biopsy report, a full list of medicines and supplements, and your follow-up schedule for oral lesions.

When to seek urgent medical care

Some changes need prompt medical review, especially for oral lichen planus, which carries a small cancer risk.^[2]

• A mouth sore, lump or white or red patch that does not heal or keeps growing
• Mouth pain that makes it hard to eat, drink or swallow
• Widespread blistering, raw skin or skin infection
• Scarring hair loss or fast nail loss
• A new rash after starting a new medicine
• New pain, bleeding or sores in the genital area

If you have trouble breathing or swallowing, or swelling of the face or tongue, call 911 or go to the nearest emergency department.