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Lichen Planus

Definition


Disease: Lichen Planus Lichen Planus
Category: Dermatological diseases
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Disease Definition:

Lichen planus, which is an inflammatory skin condition, appears as rows of itchy, flat-topped bumps (lesions) on the arms and legs. In some cases, this condition could cause pain, soreness or a burning sensation when it affects the mucous membranes, particularly in the mouth and genitals.

Lichen planus isn't an infectious disease and isn't contagious. But it can be persistent, lasting months or even years and it may reappear later. Treating this condition could be difficult. Certain self-care measures, such as cool compresses and tub soaks could be of help. In some cases, to reduce the itching and inflammation of more-bothersome symptoms prescription ointments or creams may be needed.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Lichen planus usually appears on the insides of the wrists, ankles and forearms as an itchy rash. This rash could also appear on the scalp, lower back, vagina, penis, anus, nails and neck. When lichen planus involves the nails or scalp, it could cause scarring.

Some of the signs and symptoms of lichen planus may include:

 

  • Itching, which could be severe
  • Rows of flat-topped bumps that could be pink, red or purple.
  • When it involves the scalp, it could cause redness, irritation, thinning of the hair and hair loss.
  • When it involves the mucous membranes, it could cause soreness or a burning sensation.
  • When it involves the nails, it could cause nail loss or grooving, splitting and thinning nails.


The initial attack could persist for weeks or months, and recurrences could continue over many years. Additionally, dark brown or gray spots could linger on the skin once the rash resolves. If someone has darker skin, these symptoms could be more noticeable.

Oral lichen planus could be the only evidence of the disease, appearing before the skin rash. Some of the signs and symptoms of oral lichen planus may include:

 

  • Red and open sores in the mouth
  • Small, pale, raised areas or bumps that form a lacy network inside the cheeks or on the tongue.
  • Dry mouth
  • Pain, tenderness, itching or burning in the mouth
  • A metallic taste or a blunted taste sensation
  • Shiny, red, slightly raised patches on the tongue or cheeks


In case someone suspects that they have lichen planus, especially if it involves the mucous membranes of the mouth or genitals, they should consult their family doctor or a dermatologist. To reduce inflammation and itching, they may be recommended a treatment plan. The changes in the affected tissues will be monitored by the doctor.
In case someone’s signs and symptoms worsen or they don't improve with self-care measures, the person should also seek medical advice. To manage this problem, a stronger medication may be needed.

Causes:

What exactly causes lichen planus is still not known. Its source can't be determined in most cases. However, in some cases, it could be associated with infections, such as hepatitis C. In other cases, an allergic or immune reaction to a medication or other substance seems to trigger it.

Lichen planus could develop in anyone of any race or age. However, this condition seems to be more common in middle-aged adults, and is most common in women. Someone’s risk of developing this condition could increase in case they have liver disease, such as the hepatitis C viral infection or cirrhosis, which is scarring of the liver.

Complications

Complications:

Lichen planus could clear up with treatment; however, it could persist for months to years. This condition is usually noncancerous (benign), however, anyone with long-term lesions of the mucous membranes are at greater risk of squamous cell carcinoma, which is a form of skin cancer. In this case, to monitor any changes in the mucous membranes or the skin, the patient may be recommended regular examinations. Also, because tobacco raises the risk of squamous cell carcinoma, stopping its use is quite important.

Treatments:

Usually, within several months to two years, this condition clears out on its own without treatment. Usually, only self-care measures and periodic observation by the doctor is required for the mild cases. Ointments or creams that reduce inflammation and itching could be used for more-bothersome symptoms.

Some of the treatment options may include:

 

  • Phototherapy with ultraviolet light
  • Antihistamines
  • Topical corticosteroid creams or ointments
  • A cream or ointment that contains a steroid-sparing immune-modulating medication, such as tacrolimus or imiquiod.
  • In severe cases, oral corticosteroid medications.


Treatment for lichen planus of the mucous membranes could take years and could be challenging. In this case, the patient may be prescribed oral corticosteroid medications in addition to high-potency corticosteroids applied to the affected areas.

Prognosis:

Not Available

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