Lichen planus is a disorder that causes changes to the skin and/or mouth.Lichen planus is NOT contagious.
It generally affects middle-aged men and women and is uncommon in children.
Many cases of skin lichen planus go away within 2 years. About 20% of people will experience a recurrence. In some people, the skin problem may come and go for years.
Lichen Planus of the Skin
Lichen planus usually causes bumps that can be shiny, firm and reddish. The rash of lichen planus usually cause itching.
The bumps often appear symmetrically on both sides of the body, particularly the wrists, lower back, and ankles. However, they can appear anywhere, including the scalp and genitals.
New bumps may develop as older bumps fade.
The bumps of lichen planus may rarely develop into blisters.
Lichen Planus of the Mouth
Lichen planus commonly occurs inside the cheeks, on the tongue, lips, and gums. Symptoms may include the following:
- Tender or painful sores (there may be no discomfort from mild cases)
- Tiny white dots and lines that form a lacy-looking network
- Gradual increase in size of the affected area
- Dry mouth and/or a metallic taste
Lichen planus in the mouth often lasts longer than lichen planus on the skin.
Lichen Planus of the Nails
Lichen planus can affect the toenails and/or fingernails. It may affect just a few nails, or all the nails on one foot or hand.
The nails may appear with ridges or thinning. In some cases, the nail can stop growing altogether.
Other symptoms of Lichen Planus
- Lichen planus can affect the scalp resulting in reddish, itching bumps on the head and areas of hair loss.
- Lichen planus can develop on the genitals. Here the lesions can ulcerate and become quite painful.
Causes and Risk Factors for Lichen Planus
The exact cause of lichen planus is unknown. However, it is may be an autoimmune disorder caused by the body's own immune system attacking normal tissue in the skin and mouth.
People infected with hepatitis C also appear to be at greater risk of developing lichen planus.
Some medications, such as diuretics, can cause a rash that looks like lichen planus. Stopping the medication will lead to rapid improvement.
Diagnosis of Lichen Planus
A skin biopsy or biopsy of a mouth lesion can confirm the diagnosis. Blood tests may be done to rule out hepatitis.
Treatment of Lichen Planus
The goal of treatment is to reduce symptoms and speed the healing of lesions. Treatment may not be necessary in mild cases.
Treatments may include:
- Antihistamines to control the itch
- Oral lidocaine to numb the lesions in the mouth to make drinking and speaking less painful
- Topical corticosteroids, such as clobetasol, to reduce the itch
- Oral corticosteroids, such as prednisone, to reduce swelling and suppress immune responses
- Corticosteroids may be injected right into a lesion
- Topical retinoids to reduce itching and swelling and aid healing
- Calcineurin inhibitors, such as tacrolimus and pimecroliumus, to reduce itch
- Oral retinoids, such as acitretin (Soriatane®)
- PUVA therapy, often used to treat psoriasis
- In severe cases, immunosuppressants may be attempted, such as cyclosporine
Your doctor will recommend a treatment plan based on the location of the lesions, the severity of symptoms, the presence of other medical conditions, and responses to past treatments.
As lichen planus heals, it often leaves dark brown spots on the skin called post-inflammatory hyperpigmentation. These spots usually fade over time without treatment, but there are treatments available that can lighthen them, including topical retinoids, chemical peels and laser/light treatments.
Mouth ulcers that persist for a long time are at risk of developing into oral cancer.
Image courtesy of Craig Heilman, M.D.