Lichen Planus

  • Definition

    Lichen planus is a chronic skin condition. It causes itchy, flat, scaly patches on the wrists, legs, trunk, or genitals. It can also affect the inside of the mouth and vagina. There it resembles a white spider web. It may ulcerate. Rarely, it can also become cancerous. The scalp and fingernails can also be affected. It may become wart-like in thickness. Lichen planus may continue on and off for months or years. Scratching makes this condition worse.
    Section of Skin with Lichen Planus
    Lichen Planus
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  • Causes

    Not much is known about the cause. It is possibly an immunologic reaction due to genetic factors. It mat be brought on by certain medications or diseases.
  • Risk Factors

    Lichen planus is more likely to occur in the presence of:
    • Hepatitis C
    • Systemic lupus erythematosus
    • Certain prescription medications
    • Graft vs. host disease
    • Dental materials
    The condition is more common in females. It is also more common and in those 30 to 60 years old. Lichen planus is rare in children and the elderly.
  • Symptoms

    Lichen planus may cause:
    • Itching, flat-topped purplish bumps or scaly patches—especially on the palm side of the wrists, the top of the foot and shins, the trunk, or the genitals
    • Hair loss
    • Abnormal appearance to the nails
    • Milky-white, spider web-like patches in your mouth or vagina, with or without burning or discomfort
  • Diagnosis

    Your doctor will ask about your symptoms, medications, and medical history. A physical exam will be done. Usually can be diagnosed by the appearance of the rash. You may be referred to a dermatologist.
    If the diagnosis is unclear, a skin biopsy may be done.
  • Treatment

    Talk with your doctor about the best plan for you. Treatment options include the following:
    Symptom Relief
    • Topical or oral antihistamines to relieve itching
    • Other topical anti-itching products, such as menthol or eucalyptus oil
    • Soothing oatmeal baths
    Steroid Medications
    Topical steroids may be used to help decrease inflammation. Steroids may also be injected by a needle directly into a lesion. Oral or IV steroids are only used in severe cases.
    Other Treatments
    • Retinoids or immunomodulating medications may be useful, particularly for lesions in the mouth or vagina
    • Ultraviolet light combined with oral medication has also been effective in widespread or resistant cases
  • Prevention

    There are no current guidelines to prevent lichen planus. Avoid any medications that may have triggered it in the past.
  • RESOURCES

    American Academy of Dermatology http://www.aad.org

    DermNet NZ http://www.dermnetnz.org

    CANADIAN RESOURCES

    Canadian Dermatology Association http://www.dermatology.ca

    Dermatologists.ca http://www.dermatologists.ca

    References

    Beers MH, Berkow R. The Merck Manual. 17th ed. West Point, PA: Merck & Co; 1999.

    Gorouhi F, Solhpour A, et al. Randomized trial of pimecrolimus cream versus triamcinolone acetonide paste in the treatment of oral lichen planus. J Am Acad Dermatol. 200757(5):806-813.

    Lichen planus. American Academy of Dermatology website. Available at: https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/i---l/lichen-planus. Accessed December 17, 2013.

    Lichen planus. American Osteopathic College of Dermatology website. Available at: http://www.aocd.org/?page=LichenPlanus. Accessed December 17, 2013.

    Turan H, Baskan EB, et al. Methotrexate for the treatment of generalized lichen planus. J Am Acad Dermatol. 2009;60(1):164-166.

    Wackernagel A, Legat FJ, et al. Psoralen plus UVA vs. UVB-311 nm for the treatment of lichen planus. Photodermatol Photoimmunol Photomed. 2007;23(1):15-19.

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