Overview
Lichen planus is a condition that affects the skin, hair, nails, mouth, and genitals. It often appears as purple, itchy, flat bumps on the skin, lacy white patches in the mouth and genital mucosa, and can cause painful sores. The exact cause of lichen planus is not known, but it is believed to be related to the immune system attacking cells in the affected areas. Treatment options vary depending on the severity and location of the symptoms.
Understanding the disease
Symptoms
The symptoms of lichen planus depend on the area of the body affected. For skin lichen planus, symptoms include purple, itchy, flat bumps that develop over several weeks. In the mouth and genital mucosa, lichen planus forms lacy white patches, sometimes with painful sores. Other symptoms include itchiness, painful sores in the mouth or genitals, nail scarring or loss, and dark lines from the tip of the nail to the base. For oral lichen planus, symptoms affect the mucous membranes of the mouth and may appear as lacy, white, raised patches of tissues, red, swollen, tender patches of tissues, or open sores. They may appear on the inside of the cheeks, gums, tongue, inner tissues of the lips, palate, and may cause burning sensation, pain, sensitivity to hot or spicy foods, bleeding and irritation with tooth brushing, painful thickened patches on the tongue, and discomfort when speaking, chewing, or swallowing.
Risk Factors
Some risk factors for developing lichen planus include:
- Being middle-aged, as it most commonly affects middle-aged adults.
- Having a lowered immunity due to certain disorders or medications.
- Taking certain medications that may trigger the condition, such as pain relievers or medicines that may cause an allergic reaction to dental fillings.
- Experiencing stress, which may exacerbate symptoms or cause them to recur. It's important to note that while there are potential risk factors, the exact cause of lichen planus is not yet fully understood and requires further research.
Development
Lichen planus can develop in different parts of the body, and the symptoms may vary depending on the affected area. The main symptoms of lichen planus are purple, itchy, flat bumps on the skin, lacy white patches in the mouth and genital mucosa, and painful sores. Nail disease caused by lichen planus may involve changes in nail appearance, such as purple, shiny, flat bumps or dark lines from the tip of the nail to the base. In some cases, lichen planus can also affect the ears, scalp, and eyes, potentially causing hearing loss, temporary or permanent hair loss, and scarring and blindness, respectively. It is important to note that the exact development of lichen planus is not well understood, as it is believed to be related to an irregular immune response. Certain factors, such as hepatitis C infection, pain relievers, and allergic reactions to dental fillings, may contribute to the activation of the condition. If you suspect you have lichen planus or are experiencing related symptoms, it is crucial to consult a healthcare provider for a proper diagnosis and management plan.
Assessment and Diagnosis
Triage
You should see a doctor if tiny bumps or a rash appear on your skin for no known reason or if you have any symptoms related to lichen planus of the mouth, genitals, scalp, or nails. It's important to get a prompt and correct diagnosis, as several skin and mucous membrane conditions can cause sores and pain.
Diagnosis
To diagnose lichen planus, your healthcare provider will likely discuss your symptoms and medical history, perform a physical exam, and possibly order some tests. For skin lichen planus, a biopsy may be done to examine the affected tissue in a laboratory. For oral lichen planus, your doctor will discuss your medical history, examine your mouth and other areas as appropriate, and may request additional tests such as a biopsy, culture, or blood tests. These tests help to confirm the presence of lichen planus and rule out other potential conditions.
Management and Treatment
Complications
Potential complications of lichen planus include severe pain, weight loss or nutritional deficiency, stress or anxiety, depression, scarring from erosive lesions, secondary oral yeast or fungal infections, and oral cancer. These complications can be associated with both oral and genital lichen planus. In addition, lichen planus on the scalp may cause temporary or permanent hair loss, and nail involvement may lead to nail ridges, thinning, splitting, and loss. Rarely, lichen planus may affect the mucous membrane surfaces of the eyes, causing scarring and blindness, or the esophagus, resulting in difficulty swallowing.
Home Remedies
It's important to consult with a healthcare provider for proper diagnosis and treatment of lichen planus. Home remedies may not be effective and can potentially worsen the condition.
Treatment
Treatment options for lichen planus include both symptomatic relief and addressing the underlying condition. Depending on the severity and location of the lichen planus, your healthcare provider may recommend the following approaches:
- Self-care steps: Practicing good hygiene, avoiding scratching, and using over-the-counter hydrocortisone creams can help reduce itching and inflammation.
- Topical corticosteroids: These can be applied directly to the affected area to reduce inflammation and itching.
- Oral medications: Antimalarials like hydroxychloroquine and antibiotics like metronidazole may be prescribed for oral lichen planus. Immune response medicines, such as cyclosporine and methotrexate, may be used for more severe cases.
- Light therapy: Phototherapy involving ultraviolet B light may help clear up skin-related lichen planus. However, it may cause permanent changes in skin color.
- Alternative medicine: Aloe vera gel and mouthwash may provide some relief for oral and genital lichen planus, respectively.
- Lifestyle changes: Maintaining good oral hygiene and reducing stress can help manage symptoms. Please consult with a healthcare professional to determine the most appropriate treatment plan for your specific case.
Preparing for medical consultation
To prepare for an appointment for lichen planus, you should:
- Make a list of your symptoms and how long you've had them.
- Bring a copy of all previous consultations and tests you've had regarding the issue.
- Ask if there are any preparations you need to make before the appointment, such as dietary restrictions.
- Create a list of key personal information, including any major stresses or recent life changes.
- List all medications, vitamins, herbs, or other supplements you're taking and their dosages.
- Prepare a list of questions to ask your health care provider. Some basic questions to ask your health care provider about lichen planus include:
- What's the likely cause of my symptoms?
- Are there other possible causes?
- Do I need any tests?
- What treatments are available, and which do you recommend?
- What side effects can I expect from treatment?
- How can I best manage other health conditions alongside my lichen planus?
- Are there any restrictions I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medication you're prescribing?
- Do you have any brochures or printed materials I can take with me? What websites do you recommend? Remember to be open and honest with your health care provider about your symptoms and any concerns you may have.