Lichen Planus is an inflammatory condition that affects the skin, mucous membranes (such as the mouth, genitals, and throat), and sometimes the nails and scalp. It is characterized by the appearance of purplish, flat, itchy, and sometimes painful bumps or lesions on the skin and mucous membranes. Lichen planus can be triggered by various factors and may appear suddenly or gradually.
Causes of Lichen Planus
The exact cause of lichen planus is unknown, but it is believed to be an autoimmune disorder, where the body’s immune system mistakenly attacks healthy skin or mucous membrane cells. The following factors are thought to contribute to or trigger the condition:
- Genetics: Some individuals may have a genetic predisposition to developing lichen planus.
- Infections: Hepatitis C infection has been linked to an increased risk of developing lichen planus.
- Medications: Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), antihypertensive drugs, and some antibiotics, can trigger lichen planus in susceptible individuals.
- Stress: Emotional stress or physical trauma (e.g., scratching or injury) can trigger or worsen the condition.
- Allergic reactions: Exposure to certain allergens or chemicals can contribute to the development of lichen planus.
Symptoms of Lichen Planus
Lichen planus manifests differently depending on the area of the body affected. Common symptoms include:
- Skin:
- Purple, flat-topped lesions: These are the hallmark signs of lichen planus on the skin. They may appear as small, shiny bumps that are typically itchy.
- Lesions may form in clusters or lines, often appearing on the wrists, ankles, lower back, or other areas of the body.
- Skin texture changes: In some cases, the affected skin can become thickened, scarred, or hyperpigmented after healing.
- Mouth (Oral Lichen Planus):
- White, lace-like patterns on the inside of the cheeks, gums, or tongue.
- Sores or ulcers that may be painful or cause burning sensations, especially when eating spicy or acidic foods.
- Discomfort or pain when brushing teeth or using toothpaste.
- Genitals:
- Painful sores or ulcers can appear on the genital area, leading to discomfort or pain during sexual activity.
- Nails:
- Nail changes include thinning, ridging, or even nail loss in severe cases.
- Scalp (Scalp Lichen Planus):
- Hair loss in areas where lichen planus affects the scalp, often accompanied by redness, irritation, or scarring.
- Other Symptoms:
- Itchy, burning, or stinging sensation in affected areas.
- In severe cases, blistering may occur in certain areas.
Diagnosis
To diagnose lichen planus, a healthcare provider typically:
- Examines the skin and mucous membranes to look for characteristic lesions and patterns.
- Performs a biopsy: A small sample of affected tissue may be taken and examined under a microscope to confirm the diagnosis.
- Blood tests: To rule out any underlying conditions like hepatitis or to check for markers of autoimmune activity.
- Oral examination: If oral lichen planus is suspected, a dentist or doctor may conduct an oral examination.
Treatment Options
There is no cure for lichen planus, but treatments are available to help manage symptoms and reduce flare-ups. Treatment often depends on the severity and location of the condition:
- Topical corticosteroids:
- Steroid creams or ointments are commonly prescribed to reduce inflammation and itching, especially for skin and oral lichen planus.
- Oral corticosteroids:
- For severe or widespread cases, oral steroids may be prescribed to suppress the immune system and reduce inflammation.
- Topical calcineurin inhibitors:
- These medications (such as tacrolimus or pimecrolimus) can help reduce inflammation without the side effects of long-term steroid use.
- Retinoids:
- Oral or topical retinoids (vitamin A derivatives) can help improve symptoms, especially in cases that affect the skin or nails.
- Antihistamines:
- Over-the-counter antihistamines may help relieve itching and discomfort, especially if the condition causes significant itching.
- Immune system-modulating drugs:
- In some cases, drugs that affect the immune system (such as methotrexate or azathioprine) may be used for severe or chronic lichen planus.
- Phototherapy:
- Ultraviolet (UV) light therapy may be used to treat widespread or resistant skin lichen planus.
- Supportive Care:
- Oral hygiene: For oral lichen planus, maintaining good oral hygiene and using mild, alcohol-free mouthwashes can help manage symptoms.
- Moisturizing: Regular moisturizing for the skin may help prevent dryness and irritation.
Complications
- Scarring: Chronic lichen planus, especially when affecting the skin or scalp, can lead to scarring and permanent damage.
- Increased risk of oral cancer: Oral lichen planus can increase the risk of oral cancer, particularly in severe or erosive cases, so regular dental check-ups and monitoring are essential.
- Psychological impact: The appearance and discomfort associated with lichen planus can lead to emotional distress, including anxiety and depression.
Prognosis
For many people, lichen planus can go into remission with appropriate treatment, although flare-ups may occur. The condition often resolves on its own over time, but in some cases, it can be chronic, requiring ongoing management. The prognosis varies depending on the severity, location of the lesions, and response to treatment.
