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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
    Copyright © Nucleus Medical Media, Inc.
  • Causes

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

    Lichen planus is more likely to occur in the presence of:
    The condition is more common in females. It is also more common in those aged 30-60 years. 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. Lichen planus 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 http://dermatologists.ca

    References

    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 November 6, 2015.

    Lichen planus. American Osteopathic College of Dermatology website. Available at: http://www.aocd.org/?page=LichenPlanus. Accessed November 6, 2015.

    Lichen planus. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynameds. Updated July 19, 2013. Accessed November 6, 2015.

    Lichen planus. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/dermatologic-disorders/psoriasis-and-scaling-diseases/lichen-planus. Updated November 2014. Accessed November 6, 2015.

    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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