Lichen Planus

Lichen Planus (pronounced LY -kin-PLAN-us) is a rather common disease that affects the skin, the mouth, or both. It affects about one percent of the general population. What is lichen planus? How do you get the disease? Can it be cured? This information will help answer these and other questions by taking a closer look at the disease.

What the Disease Is Not
To understand what lichen planus (LP) is, it’s important to note what the disease is not. Lichen planus is not an infectious disease. It is impossible to “catch” lichen planus from someone who has it or to give it to someone else. The disease is not a form of cancer, it does not appear to be inherited, and it is not related to nutrition.

What It Is
Lichen planus is an inflammatory disease that usually affects the skin, the mouth, or sometimes both. It may affect the genital skin as well. The cause of lichen planus is not known. There are cases of lichen planus-type rashes occurring as allergic reactions to medications for high blood pressure, heart disease and arthritis. In those cases, identifying and stopping the use of the drug helps clear up the condition within a few weeks. Some people with lichen planus can also have hepatitis C and your dermatologist may want to check you for this. Lichen planus affects men and women equally, and occurs most often in middle-aged adults.

Lichen Planus of the Skin
Lichen planus of the skin is characterized by reddish-purple, flat-topped bumps that may be very itchy. They can be anywhere on the body, but seem to favor the inside of the wrists and ankles. The disease can also occur on the lower back, neck, legs, genitals, and in rare cases, the scalp and nails. Thick patches may occur, especially on the shins. Blisters are rare. While the typical appearance of lichen planus makes the disease somewhat easy to identify, a skin biopsy may be needed to confirm the diagnosis. .

Sometimes, lichen planus of the skin causes few problems and needs no treatment. However, in many cases there is severe itching. Most cases of lichen planus go away within two years. As it heals, lichen planus often leaves a dark brown discoloration on the skin. Like the bumps themselves, these stains may eventually fade with time without treatment. About one out of five people will have a second attack of lichen planus.

There is no known cure for lichen planus but treatment is often effective in relieving itching and in improving the appearance of the rash until it goes away. Since every case of lichen planus is different, no one treatment is perfect. The two most common treatments include the use of topical corticosteroid creams and antihistamine drugs taken by mouth. Both work to help itching. More severe cases of lichen planus may require stronger medications such as cortisone taken internally or a specific form of ultraviolet light treatment called PUVA. Remember to discuss any potential drug side effects with your dermatologist prior to filling prescriptions.

As with other skin disorders, patience—and following your doctor’s advice—is the best medicine for dealing with lichen planus. You should, however, be careful not to injure your skin, since new areas of lichen planus can form in the damaged skin.

Lichen Planus of the Mouth
Lichen planus of the mouth most commonly affects the inside of the cheeks, gums and tongue. Oral lichen planus is more difficult to treat and typically lasts longer than skin lichen planus. Fortunately, many cases of lichen planus of the mouth cause minimal problems. About one in five people who have oral lichen planus also have skin lichen planus.

Oral lichen planus typically appears as patches of fine white lines and dots. These changes usually do not cause problems. Dentists during routine checkups often find them. More severe forms of oral lichen planus can cause painful sores and ulcers in the mouth. Often a biopsy of affected t issue is needed to confirm a diagnosis of lichen planus. Your doctor may have to make sure that the sores are not caused by a yeast or an infection and are not canker sores. Sometimes, several biopsies are needed at various times, along with blood tests.

There have been cases of lichen planus-type allergic reactions to dental materials but they are very rare. When an allergy by dental material has been prove n, removing dental material is recommended.

There is no known cure for oral lichen planus although there are many treatments that eliminate the pain of sores. When the disease causes no pain or burning, treatment may not be needed. More severe forms of lichen planus—those with pain, burning, redness, blisters, sores and ulcers—can be treated with a variety of medications, both applied to the sores (topical) and taken by mouth (oral). As with any disease of the lining of the mouth, lichen planus can lead to poor dental hygiene and gum disease. The American Academy of Dermatology recommends regular visits to the dentist for examinations and cleaning at least twice a year.

Lichen Planus of the Genitals
About one in five women with oral lichen planus will have lichen planus in the vaginal area. If it is mild, vaginal lichen planus may cause no problems, but red areas or open sores may cause pain, especially with sexual intercourse. Lichen planus of the genitals is less common in men than women.

Are You at Risk?
Patients with oral lichen planus may be at a slightly increased risk of developing oral cancer. Because of this increased risk, the American Academy o f Dermatology recommends discontinuing the use of alcohol and tobacco products, which also increase the risk. Regular visits to the dermatologist—every six to twelve months—for oral cancer screening are also recommended.

Food for Thought
Spicy foods, citrus juices, tomato products, caffeinated drinks like coffee and cola, and crispy foods like toast and corn chips can aggravate lichen planus especially if there are open sores in the mouth.

Nail Involvement
Nail changes have been observed in lichen planus cases. The majority of nail changes results from damage to the nail matrix, or nail root. Usually only a few fingernails or toenails are involved, but occasionally all are affected. Nail changes associated with lichen planus include longitudinal ridging and grooving, splitting, nail thinning and nail loss. In severe cases, the nail may be temporarily or permanently destroyed.

Hair Involvement
In rare cases, lichen planus can affect hairy areas such as the scalp. This is called lichen planopilaris, and can lead to redness, irritation, and in some cases, permanent hair loss.

More on Lichen Planus
Lichen planus is a stable condition—the severity and distribution of the disease rarely changes after the first two months. While there are many theories to explain lichen planus, many dermatologists believe it can be classified as an autoimmune disease. This means that white blood cells, which usually fight germs, begin to attack the normal parts of the skin, mucous membranes, hair and nails.