Lichen Planus : Symptoms, Causes, Diagnosis, Management and Prevention

Lichen Planus : Symptoms, Causes, Diagnosis, Management and Prevention

Lichen planus is an inflammatory skin disorder. The disease presents itself in the form of papules, lesions or rashes. Lichen planus is a non-infectious, itchy rash that can affect many areas of the body.

Lichen planus may be divided into the following types:

Configuration:

  • Annular lichen planus
  • Linear lichen planus

Morphology of lesion:

  • Hypertrophic lichen planus
  • Atrophic lichen planus
  • Vesiculobullous lichen planus
  • Ulcerative lichen planus
  • Follicular lichen planus
  • Actinic lichen planus
  • Lichen planus pigmentosus

Site of involvement:

  • Lichen planus of the palms and soles (Palmoplantar lichen planus)
  • Mucosal lichen planus
  • Lichen planus of the nails
  • Lichen planus of the scalp ( leading to cicatricial alopecia)
  • Inverse lichen planus

Special forms:

  • Drug-induced lichen planus
  • Lupus erythematosus-lichen planus overlap syndrome
  • Lichen planus pemphigoides
  • Keratosis lichenoides chronica
  • Lichenoid reaction of graft-versus-host disease
  • Lichenoid keratosis
  • Lichenoid dermatitis

Symptoms :

The symptoms of lichen planus vary according to area of the body are affected. The most common symptoms are seen in

  • The mouth
  • The skin
  • The vulva (external female sex organs) and vagina
  • The penis

The symptoms of lichen planus of the mouth are:

  • A white pattern on the tongue and inner cheeks
  • White and red patches in the mouth
  • Burning and discomfort in the mouth while eating or drinking
  • Painful, red gums
  • Recurring mouth ulcers

Symptoms of lichen planus of the skin are:

  • Purple-red coloured papules that are slightly raised, shiny and have a flat top
  • The papules usually measure 3-5mm in diameter
  • The papules may also have irregular white streaks (Wickham’s striae)
  • Thicker scaly patches can appear, usually around the ankles – this is known as hypertrophic lichen planus
  • Itchy skin

Lichen planus of the vulva and vagina:

The symptoms of lichen planus of the vulva and vagina include:

  • Soreness, burning around the vulva
  • The vulva may be covered in white streaks and be a red, pink or pale white colour
  • If the vagina is affected, sexual intercourse can be painful
  • If the outer layers of skin break down, moist, red patches can form
  • Scar tissue can form, which distorts the shape of the vagina
  • A sticky, yellow or green discharge, which may be bloodstained
  • The opening of the vagina can become narrowed

Lichen planus of the penis:

The symptoms of lichen planus of the penis are:

  • Purple or white ring-shaped patches on the tip of the penis (glans)
  • Papules that are flat-topped and shiny
  • The rash is often not itchy

Causes :

The exact reason for Lichen planus is still unknown. However, it is related to either the immune system (the body’s natural defense against infection and illness) or an allergic reaction to certain medicines.

  • Beta blockers – Medications that relieve stress on the heart, slow the heart beat, lessen the force of heart muscle contractions, and reduce blood vessel contraction in the heart, brain, and throughout the body.
  • Diseases such as Hepatitis C
  • Anti-inflammatory medications
  • Antimalarials Thiazide diuretics Phenothiazines (a group of tranquilizing drugs with antipsychotic actions).

Diagnosis :

It is often diagnosed through physical examination.

Biopsy: biopsy is also done at times, where skin is examined under microscope.

Management :

Medicines used to treat lichen planus include:

  • Oral and topical steroids.
  • Oral retinoids
  • Immunosuppressant medications
  • Hydroxychloroquine Creams and ointments that contain corticosteroids (artificial hormones) are often used to treat inflammatory skin conditions.

Complications :

Complications of lichen planus may include discoloured skin and in some cases, erosive lichen planus may develop into certain types of cancer.

Skin pigmentation: After the lichen planus rash has cleared up, a change in skin color may occur (a brown or gray mark), which can sometimes last for months. This is known as post-inflammatory hyperpigmentation and is more noticeable in people with darker skin.

Erosive lichen planus: Erosive lichen planus is a long-lasting (chronic) form of lichen planus that causes painful ulcers to develop, and burning and discomfort in the male and female genital areas. Long-term cases of erosive lichen planus can develop into certain types of cancer,

For example:

  • Mouth cancer
  • Vulval cancer
  • Penile cancer

Note : This  information provided in the website of AIMU is only for  understanding the subject . If one has such symptoms/ condition, he/she should consult a doctor for diagnosis and treatment.

References:

www.nhs.uk
www.aad.org
www.ncbi.nlm.nih.gov
www.nlm.nih.gov

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