Lichen Planus

Providing the most advanced Lichen Planus Treatments

What is Lichen Planus?

Lichen planus is a common inflammatory disease that affects about 1-2 percent of the general population. It is a rash characterized by flat-topped, reddish-purplish lesions that most often appear on the wrists, forearms, shins, and ankles. In rare cases, it can also affect the hair, nails and mouth. The major complaint is itching, which is often severe.

Lichen Planus is not an infectious disease. It is impossible to catch Lichen Planus from someone or to give it to someone else. The disease is not a form of cancer, it does not appear to be inherited, and it is not related to nutrition.

Lichen Planus affects the skin, the mouth (oral), or both. It may also affect the genital skin. Skin Lichen Planus affects men and women equally, but oral Lichen Planus affects women twice as often as men. Lichen Planus occurs most frequently in middle-aged adults. The cause of Lichen Planus is not known. While there are many theories to explain Lichen Planus, most dermatologists believe it can be classified as an autoimmune disease. This means that white blood cells which usually fight germs begin to attack the normal parts of the skin, mucous membranes, hair, and nails. There are cases of lichen planus-type rashes which occur as allergic reactions to medications for high blood pressure, heart disease, and arthritis. Identifying and stopping the drug helps clear up the condition within a few weeks. Some people with Lichen Planus can also have hepatitis C, and the dermatologist may check for it.

Lichen Planus of the skin is characterized by reddish-purple, flat-topped bumps that may be very itchy. Some may have a white lacy appearance called Wickham’s Striae. They can be anywhere on the body, but seem to favor the inside of the wrists and ankles. The disease can also occur on the lower back, neck, legs, genitals, and in rare cases, the scalp and nails. Lichen Planus on the legs is usually much darker in appearance. There may be thick patches (hypertrophic Lichen Planus) especially on the shins. Blisters are rare except in special cases called bullous Lichen Planus. While the typical appearance of Lichen Planus makes the disease somewhat easy to identify, a skin biopsy may be needed to confirm the diagnosis.

Lichen Planus of the skin usually causes few problems and needs no treatment. If there is severe itching there is help. Many cases of Lichen Planus go away within two years. As it heals, Lichen Planus often leaves a dark brown discoloration on the skin. Like the bumps themselves, these stains may eventually fade with time without treatment. About one out of five people will have a second attack of Lichen Planus.

Treatment for Lichen Planus

Lichen Planus may be unpleasant and difficult to treat, but it is a stable condition. The severity and distribution of the disease rarely changes after the first few months. Although there is no cure for Lichen Planus, Elan MediSpa and The Dermatology Center at Old Bridge can develop a treatment plan to control your symptoms.

Treatment for Lichen Planus of the Skin

There is no known cure for Lichen Planus but treatment is often effective in relieving itching and in improving the appearance of the rash until it goes away. Since every case of Lichen Planus is different, no one treatment is perfect. The two most common treatments include the use of topical corticosteroid creams, ointments, or other anti-inflammatory drugs, and antihistamines taken by mouth. More severe cases of Lichen Planus may require stronger medications such as cortisone taken internally or a specific form of ultraviolet light treatment called PUVA. Discuss any potential drug side effects with your dermatologist.

As with other skin disorders, following your dermatologist’s advice is the best approach for dealing with Lichen Planus. Since new areas of Lichen Planus can form in the damaged skin, try to avoid injury.

Lichen Planus of the Mouth

Lichen Planus of the mouth most commonly occurs inside of the cheeks, but can affect the tongue, lips, and gums. Oral Lichen Planus is more difficult to treat and typically lasts longer than Lichen Planus on the skin. Fortunately, many cases of Lichen Planus of the mouth cause minimal problems. About one in five people who have oral Lichen Planus also have skin Lichen Planus.

Oral Lichen Planus typically appears as patches of fine white lines and dots which usually do not cause problems. Dentists often find them during routine check-ups. More severe forms of oral Lichen Planus can cause painful sores and ulcers in the mouth. Your dermatologist may have to make sure that the sores are not caused by a yeast or an infection and are not canker sores. A biopsy of affected tissue may be needed to confirm a diagnosis. Sometimes, the biopsy tissue must be studied by a special technique and blood tests may be needed to rule out other oral diseases.

There have been cases of lichen planus-like allergic reactions to dental materials but they are very rare. Patch testing may be used to pinpoint the allergy; removing dental material is recommended.

Treatment for Lichen Planus of the Mouth

There is no known cure for oral Lichen Planus although there are many treatments that eliminate the pain of sores. When the disease causes no pain or burning, treatment may not be needed. More severe forms of Lichen Planus — those with pain, burning, redness, blisters, sores, and ulcers — can be treated with a variety of medications, both applied to the sores (topical) and taken by mouth (oral). As with any disease of the lining of the mouth, Lichen Planus can lead to poor dental hygiene and gum disease. Careful daily oral hygiene is very important. Schedule regular visits to the dentist for examinations and cleanings at least twice a year.

Are you at risk for Lichen Planus of the Mouth?

Patients with oral Lichen Planus may be at a slightly increased risk of developing oral cancer. Because of this increased risk, it is wise to discontinue the use of alcohol and tobacco products which also increase the risk. Regular visits to the dermatologist — every six to twelve months — for an oral cancer screening is recommended.

Spicy foods, citrus juices, tomato products, caffienated drinks like coffee and cola, and crispy foods like toast and corn chips can aggravate Lichen Planus especially if there are open sores in the mouth.

Lichen Planus of the Genitals

Lichen Planus of the genitals is less common in men than women. About one in five women have vulvar or vaginal Lichen Planus. There may be no problems if it is mild, but red areas or open sores may cause pain, especially with sexual intercourse and needs treatment.

Nail Involvement

Nail changes have been observed in Lichen Planus. The majority of nail changes result from damage to the nail matrix, or nail root. Only a few fingernails or toenails are usually involved, but occasionally all are affected. Nail changes can occur with or without skin involvement.

Nail changes associated with Lichen Planus include longitudinal ridging and grooving, splitting, nail thinning, and nail loss. In severe cases, the nail may be temporarily or permanently destroyed.

Scalp Involvement

Lichen Planus can affect hairy areas such as the scalp in rare cases. This is called lichen planopilaris, and can lead to redness, irritation, and in some cases, permanent hair loss.

 

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