What is Lichen Planus?

This inflammatory disease is triggered by an inaccurate immune system response and is considered relatively common.  Most typically, lichen planus affects the skin inside the mouth but can also occur anywhere on the epidermis. Lichen Planus causes itchy, red lesions that are distinctive in appearance.

It can either occur suddenly or develop over time and affects approximately 1% of the world’s population. Though women and men of all races are susceptible, oral lichen planus affects twice as many females as it does males. It is not common in very young and very old populations. 

There are various forms of Lichen Planus, including: 

• Atrophic
• Ulcerative
• Bullous
• Annular
• Linear
• Inverse
• Lichen planopilaris 

What causes Lichen Planus? 

Experts know what lichen planus is not, but are still struggling to nail down what prompts this unhealthy immune system response. Lichen Planus is not contagious nor is it a form of cancer, yet the exact causes of this inflammatory disease has yet to be identified. In certain instances, lichen planus has been tied to contact with certain chemicals, hepatitis C infection, and medications. Although, it’s worth noting that triggers vary greatly from person to person. 

Medication for high blood pressure, heart disease, malaria, NSAIDs, painkillers, and other common prescription medication have prompted the onset of Lichen Planus. Once the drug treatment is stopped, the inflammatory rash typically subsides. Other allergies to oral medication, dental products, and edible ingredients may cause oral lichen planus. 

Signs and symptoms of lichen planus

At first, lichen planus presents itself as tiny, flat-topped, reddish bumps with irregular shapes. Some may be a little larger and rounder than others, although the majority remain small and asymmetrical. Depending on the person and circumstance, they may notice a large swath of inflammatory bumps or just a few lesions. 

Upon closer inspection, the bumps may have white flakes or gray streaks (called Wickham’s Striae). In most individuals, lichen planus is itchy, – but the severity varies. Most commonly, this inflammatory condition happens in the mouth, on the insides of the wrists, ankles, scalp, and arms. When it affects the scalp, hair loss can occur. 

Signs of lichen planus may include: 

• Red bumps on the scalp
• Split nails 
• Lacy white patches on the cheeks and tongue 
• Painful ulcers in the mouth
• Sores on female genitals (often confused with sexually transmitted diseases)

Symptoms caused by lichen planus may include: 

• Dry mouth
• Blistering gums
• Loss of taste
• Metallic taste
• Irritation or pain when eating spicy and acidic food
• Pain when having intercourse
• Discharge from the penis or lesions on the vagina
• Hair loss

Complications

While lichen planus is treatable, it is not curable. There are some complications that may arise depending on how bad one’s condition is or how long they’ve waited to seek treatment. 

Here are some common complications brought on by this inflammatory disease: 

• Hyperpigmentation. Even once the lesions clear, skin may stay discolored and not return back to its original pigmentation. This tends to more drastically affect individuals with darker skin.  
• Alopecia. When lichen planus appears on the scalp, it forms plaques that encircle hair follicles, often causing hair loss. If these lesions scar, permanent hair loss in those areas is highly likely as the actual follicle will remain plugged with scar tissue.
• Erosive Lichen Planus. When this rash appears on the genitals, the skin affected may be red, raw, and painful. This would limit an individual’s intimate life, reproductive goals, and overall mental health. 
• Vulva Erosions. As lichen planus covers the labia majora, minora, or other parts of the vagina, scar tissue, fusion, and erosion can occur, instigating the need for surgery. 
• Esophageal Stenosis. As lesions take over the throat – growing on the esophagus and windpipe – severe dysphagia may occur. This makes it difficult and painful to talk, sing, yell, and swallow. Weight loss, malnutrition, pneumonia, muscle loss, and malaise due to depression may occur. 
• Psychological effects. No which part of the body that lichen planus affects, patients experiencing this inflammatory condition may have severe psychological complications. Oral, genital, and scalp can wreak havoc on one’s confidence, physical well-being, ability to interact, to date, to eat, to partake in all of the things that make life so beautiful. 

Diagnosis

Diagnosing lichen planus involves the consultation of a dermatologist. They can diagnose the disease with a biopsy of the lesion. Additionally, they may order a hepatitis C test, which can be a main trigger of the disease. Through the process of elimination, allergy tests can be done as well to figure out if medication, food, or environment triggers are to blame. 

Treatments

There are a variety of treatments for people with lichen planus and all depend on the location and severity of the rash. The majority of cases clear up with drug intervention, like taking corticosteroids or applying a topical steroid cream. 

Additionally, here are other treatment options that handle the lesions and their symptoms. 

• Injection of corticosteroid into large, plaque lesions
• Topical creams containing corticosteroids 
• UV therapy
• Oral medication including prednisone, acitretin, and other immunosuppressant drugs
• Lidocaine and other painkillers to help with oral or genital lesions 
• Prescription antihistamines 

Home Remedies

To handle symptoms while treating lichen planus, there are a plethora of home remedy options available to most. These deal with itching, pain, burning, and may help prevent scarring from said lesions. 

• Topical application of aloe vera
• Oat baths 
• Warm showers or baths 
• Drinking green tea
• Chewing sage leaves
• Ingesting turmeric either in capsule or powdered form to deal with inflammation  
• Any over the counter antihistamine like benadryl or calamine lotion

Appointments and Next Steps

Lichen planus is not a curable disease however, it is very treatable. Many people with it don’t even need treatment as the lesions clear up on their own. However, for bumps and rashes that persist and affect daily life, treatment should absolutely be sought to mitigate any complications from this autoimmune disorder.  
Contact a Lake Nona dermatologist in UCF Health’s extensive network to learn more about lichen planus. If you believe you have symptoms, it’s important to receive a correct diagnosis and begin treatment. Our online patient portal is easy to navigate and provides relevant information – including COVID-19 updates for patients and online scheduling tools.