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Lichen Planus

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  3. Lichen Planus

Overview of Lichen Planus

Lichen planus also known as (Jild ki bemariyon me se aik qisamجِلدکی بيمارِيوں ميں سے ايکقسم) is the inflammation (swelling and irritation) of skin, hair, nails and mucous membranes. Once the skin gets affected by lichen planus, it usually appears as a purplish, itchy, flat lesion for several weeks. Other areas like the mouth, vagina, etc. are surrounded by mucous membranes in which white lacy painful patches or lesions appear. 

Typically, lichen planus can be managed at home, without prescription drugs. So, you can try to relieve this disease with home-made ingredients. It is not contagious like other skin diseases.

Lichen Planus Prevalence

About 1 in 100 people suffer from Lichen planus worldwide, mostly affecting adults over the age of 40 years. Among all types of lichen planus, about half of the population suffer from oral lichen planus and is more prevalent in women than in men. Almost 10% of lichen planus affects the nails mostly.

Signs and Symptoms of Lichen Planus

Some of the most common symptoms of lichen planus are listed below:

  • Purplish coloured blisters with flat tops on the skin or genitals 
  • Blisters spread all over the body after several weeks and months
  • Feeling itchy at the specific rash area
  • Painful lacy white blisters inside the mouth that cause a burning sensation 
  • Scaly like skin due to bursting of blisters
  • Thin white lines on the area of rash

The duration of blisters appearing on skin can be several weeks to months. The visible blisters may spread to other areas. Individuals usually get rid of this condition within 6 to 16 months.

Besides the skin or genitals, the blisters can also less commonly appear on following areas:

  • Mucous membranes
  • Nails
  • Scalp

Types of Lichen Planus

There are various types of Lichen planus depending on the affected area and the characteristics of purple lesions.

Following are the types of Lichen planus and how they affect a person.

  • Hypertrophic Lichen planus- In this type, small purple lesions appear n arms, hands, legs, feet and ankles. It can cause severe itchiness. After removal of lesions, it can leave pigmentation marks and residual scars. 

  • Atrophic Lichen planus- It can occur anywhere on body especially legs and trunk area. It appears as pale plaque with central disruption of tissues. 

  • Erosive Lichen planus- It can cause ulcer formation. It affect the mucosal surface of mouth (oral lichen planus) and genital area (vulval-vaginal lichen). 

  • Follicular Lichen planus- Also known as follicular planopilaris, it is a rare inflammatory condition that mainly cause permanent hair loss particularly on the scalp. It also causes scarring on the skin. It appears as formation of keratotic plugs on the nails and hair. 

  • Annular Lichen planus- This too, is a rare form of lichen planus and it affects mostly mouth or skin. In this condition, affected people develop slightly raised, ring shaped, purple lesions with no tissue breakdown (central atrophy).

  • Linear Lichen planus- In this type, affected people would develop itchy purple flat-topped papules linearly along with black lines appear on anywere in the body but majorly on arms and legs. 

  • Vesicular and Bullous Lichen planus- In this form, lesions appear on the limbs or in the mouth from preexisting Lichen planus. 

  • Actinic Lichen planus- In this condition, a person develop discoid patches with hypopigmented zones around a hyperpigmented centre that can appear on nails, scalp, mucous membranes and covered areas of the body. 

  • Lichen planus pigmentosus- This condition mostly affect the face and nek region of our body. 

  • Lichen planus pemphigoides- It is a combination of lichen planus and bullous pemphigoides. It appears as purple coloured shiny flat topped firm lesions that appear on the lichen skin or normal skin. It can affect any part of the body.

Causes of Lichen Planus

Following are the associated causes of lichen planus that may be possible but still researchers are still finding the exact cause.

  • Hepatitis C triggers the lichen planus
  • Some medications such as drugs for the treatment of high blood pressure, diabetes, heart disease, and malaria
  • Metal-filling reactions inside the teeth
  • An autoimmune disorder in which the body's defence mechanism attacks the immune system on its own. Due to this, skin cells and mouth are affected
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Risk Factors of Lichen Planus

People who are susceptible to lichen planus may have following possibilities:

  • Had a family History
  • Allergic to certain chemicals
  • Hepatitis C affected people

Below are the factors that enhance the lichen planus through different chemicals, medications etc.

  • Antibiotics
  • Arsenic
  • Gold
  • Iodide compounds
  • Drugs like diuretics, diabetic, hypertensive, etc.
  • Certain kinds of dyes

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Prevention

There are no known ways to prevent lichen planus. However, good lifestyle habits, avoiding injuries and scratching are some of the ways that can make your disease manageable.

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Diagnosis

Dermatologists ask the questions from the patients to collect the medical and family history. On the basis of it, the doctors further proceed the diagnosis through various lab tests. General lab tests of lichen planus are as follows:

  • Skin Biopsy: In the skin biopsy test, firstly scrap a small fragment of affected tissues from the skin and examine it under a light microscope. This helps to determine the specified cell patterns of lichen planus

  • Hepatitis C Test: It is an activator of lichen planus that’s why doctors usually recommend hepatitic C test for some people. 

  • Allergy Tests: The allergy test usually recommends diagnosing any allergy in patients that may trigger the lichen planus.

A doctor may recommend other tests if they suspect any variations of lichen planus such as areas affecting oesophagus, genitals, ears or mouth.

Treatment of Lichen Planus | When to Consult a Doctor

Typically, the basic management of lichen planus begins at home.If the symptoms get worse then it can be treated with medications. All depends on the severity of the disease. 

Home Treatments

There are the following ways an infected person may try at home to relieve the  lichen planus on a temporary basis.

  • Clean the skin with oatmeal bath
  • Avoid scratching on the face
  • Apply cool material on rash 
  • Using OTC anti-itching creams

 Note: If you are using OTC drugs, consult your doctor before taking it.

Other Medical Therapies:

People with acute lichen planus may recover on their own within a few weeks or months as there is no specific treatment needed. If lichen planus become chronic, below are the effective medications that doctors may prescribe:

  • Corticosteroids- These are the first choice of treatment to control the spread of disease. It helps to reduce inflammation and administer it in the form of different preparations, including Creams, Gels Oral drugs and Injections.
  • Antihistamines- It helps to reduce the inflammation of the specific area or decrease the intensity of rash for those sensitive patients who are allergic to specific products. Following are the  effective antihistamines agents Azathioprine (Azasan, Imuran), Mycophenolate (Cellcept), Cyclosporine (Gengraf, Sandimmune, others) and Methotrexate (Trexall).
  • Nonsteroidal Creams- It is used to relieve pain and treat the lesions of lichen planus. It is directly applied on the skin topically to reduce skin rashes.
  • Oral anti-infections drugs- Like anti-malarial drugs may use in certain conditions for the treatment of lichen planus that are Hydroxychloroquine (Plaquenil) and Metronidazole (Flagyl, others)
  • Light Therapy (phototherapy)- In this technique, UV light penetrates through the upper layer of skin to scrape off the affected skin. The duration of the light therapy session is about two to three treatments a week.
  • Retinoids- It correlates with vitamin A, which doctors usually prescribe either topically or orally. Retinoid medications  are given when a person does not treat properly with corticosteroids or light therapy For example, acitretin (Soriatane) is given orally.

Pregnant women or being pregnant should not take retinoids  during pregnancy. These can cause potential birth defects in the foetus.

 

If the lichen planus is not managed  by home remedies and the symptoms get worse day by day then consult a physician as soon as possible.

 

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