Lichen planus

Lichen Planus

Lichen planus is a rare, inflammatory condition that primarily affects the skin, mucous membranes, hair, and nails. It is characterized by itchy, purplish, flat-topped bumps or plaques, often with a shiny surface. While it can affect various parts of the body, the condition typically involves the skin and mucosal surfaces, including the mouth, genitals, and nails.

Causes

The exact cause of lichen planus is not fully understood, but it is believed to be an autoimmune disorder, where the body's immune system mistakenly attacks healthy cells, particularly in the skin and mucous membranes. Various factors may contribute to its development:

1. Immune system dysfunction: The immune system may become overactive, attacking cells of the skin and mucous membranes.
2. Genetic predisposition: Some people may have a genetic tendency to develop lichen planus, though no single gene has been identified.
3. Infections: Certain viral infections, particularly the hepatitis C virus, have been associated with the development of lichen planus.
4. Medications: Certain medications, including blood pressure drugs (like ACE inhibitors), nonsteroidal anti-inflammatory drugs (NSAIDs), and some antibiotics, may trigger or worsen lichen planus.
5. Stress: Emotional stress has been suggested as a possible trigger in some individuals.

Symptoms

Lichen planus can affect different areas of the body, with symptoms varying based on the site of involvement. Common symptoms include:

1. Skin:
   • Purple, flat, itchy bumps: These are the hallmark of lichen planus. They often appear on the wrists, ankles, lower back, and genital areas.
   • Shiny surface: The lesions usually have a shiny or glossy appearance.
   • Blisters: Occasionally, fluid-filled blisters can develop.
   • Striations (Wickham's striae): Fine white lines may appear on the surface of the lesions.
2. Mouth (Oral Lichen Planus):
   • White, lacy patches inside the mouth, often on the cheeks, gums, or tongue.
   • Sores or ulcers that may be painful.
   • Burning sensation when eating or drinking, especially with spicy foods.
3. Genitals:
   • Red, shiny, or purple lesions on the genital area, which may cause discomfort or pain.
   • Ulcers or sores that can be painful.
4. Nails:
   • Nail thinning or ridging.
   • Brittleness or loss of nails in severe cases.
5. Hair:
   • Hair loss can occur if lichen planus affects the scalp, often resulting in patches of hair loss (lichen planopilaris).

Diagnosis

Diagnosis of lichen planus is primarily based on the following:

1. Physical examination: The doctor will examine the characteristic skin lesions and mucosal involvement.
2. Biopsy: A skin biopsy may be performed, where a small sample of the affected skin is taken and examined under a microscope to confirm the diagnosis.
3. Blood tests: Blood tests may be done to rule out underlying causes, such as hepatitis C or other autoimmune diseases.
4. Mucosal swabs: In cases of oral or genital involvement, swabs or other tests may be done to rule out infections and other conditions.

Treatment

While there is no cure for lichen planus, various treatments can help manage symptoms, reduce inflammation, and prevent complications:

1. Topical corticosteroids: These are commonly prescribed to reduce inflammation and itching. They are applied directly to the affected skin or mucosal surfaces.
2. Oral corticosteroids: For more severe cases, oral steroids may be prescribed to reduce inflammation throughout the body.
3. Topical retinoids: Retinoid creams or gels can help control the skin lesions by reducing cell turnover.
4. Immunosuppressive medications: Drugs like tacrolimus or cyclosporine may be used to suppress the immune response in more severe cases.
5. Phototherapy: UV light therapy (narrowband UVB) may be recommended for widespread or severe skin involvement.
6. Oral treatments for oral lichen planus:
   • Topical corticosteroids or corticosteroid mouth rinses may be used.
   • Immune-modulating drugs: In some cases, oral medications like methotrexate or hydroxychloroquine may be used.
7. Pain relief: If lichen planus causes painful lesions (especially in the mouth or genital area), medications for pain management and mouth rinses may be prescribed.
8. Hair treatments: For scalp involvement, treatments to reduce inflammation and promote hair regrowth may include corticosteroids or other immunosuppressive medications.

Prognosis

• Chronic condition: Lichen planus tends to be a chronic condition, although it can sometimes resolve on its own over time.
• Recurrence: Some individuals may experience flare-ups, especially if they encounter triggers like stress or infections.
• Long-term management: For most people, managing symptoms with appropriate treatments can prevent significant complications and improve quality of life.

Complications

1. Scarring: In some cases, especially with genital or scalp involvement, scarring may occur, leading to permanent hair loss or changes in skin appearance.
2. Increased risk of oral cancer: People with long-term oral lichen planus may have a slightly increased risk of developing oral cancer. Regular dental and oral examinations are recommended for early detection.
3. Psychosocial impact: The appearance of skin lesions, especially when visible on the face or other exposed areas, can cause emotional distress or self-esteem issues.

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