Other parts of the body may also be affected by lichen planus, including the mouth, nails, scalp, vulva, vagina, and penis. Involvement in the scalp can result in hair loss - sometimes permanent.
Nobody knows the exact causes of lichen planus. However, we know it can be triggered by taking certain medications, including thiazide diuretics, antimalarials, and phenothiazines (a group of tranquilizing drugs with antipsychotic actions).
A significant number of skin specialists (dermatologists) believe it might be an autoimmune disease. According to the American Skin Association, lichen planus affects around 1 percent of Americans. It typically occurs in people over the age of 30.
Here are some key points about lichen planus.
- Lichen planus is a non-infectious, inflammatory skin disorder.
- The exact causes of lichen planus are not yet understood.
- The condition is estimated to affect 1 percent of the population.
- People with hepatitis C are more susceptible to lichen planus.
- Treatment for lichen planus may include antihistamines, phototherapy, or steroid creams.
Causes of lichen planus
The exact causes of lichen planus are still not known.
Experts are not sure of the exact causes of lichen planus. Many believe it is an autoimmune disorder, where the immune system mistakenly attacks healthy tissues.
The following is known about lichen planus:
- Non-hereditary - it does not appear to be a hereditary condition - you cannot pass it on to your children.
- Non-infectious - it is not an infectious condition - you cannot catch it.
- Non-cancerous - it is not a form of cancer.
- Not linked to nutrition - however, spicy foods, citrus juices, and tomato products may aggravate symptoms if there are open sores in the mouth.
Some causes of lichen planus are thought to involve the following:
- Medications - sometimes lichen planus can occur as a reaction to certain medicines, including:
- beta-blockers - common drugs used to treat cardiovascular problems
- anti-inflammatory medications
- gold injections - for the treatment of arthritis
- thiazide diuretics
- phenothiazines (a group of tranquilizing drugs with antipsychotic actions)
- Some substances - there is a link between contact with some chemicals used in color photographic development and lichen planus.
- Mercury tooth fillings - some studies have found a link between lichen planus type changes in the mouth as a result of an allergic reaction to mercury tooth fillings.
Lichen planus: Common symptoms
The rash appears abruptly and usually lasts several months.
Symptoms vary depending on the site of the condition. The first attack can continue for weeks, and even months, while recurrences can go on for years - recurrences are more common in cases of oral lichen planus.
When symptoms are gone, there may be dark brown or gray spots on the skin, which are more noticeable if the patient has dark skin.
Symptoms of lichen planus of the skin
- The rash appears abruptly and usually lasts for several months.
- There are clumps or patterns of shiny, raised, red/pink/purple, flat-topped papules (bumps).
- Papules are approximately 3-5 millimeters in diameter.
- Sometimes there are white streaks on the papules, called Wickham's striae.
- Intense itching, especially at night.
Most affected areas are the wrists, elbows, ankles, and lower back. However, other parts of the body may be affected. The shins can be affected by hypertrophic (thickened) lichen planus, while the armpits might have annular (ring-shaped) lichen planus.
Symptoms of oral lichen planus (affects the mouth)
- White streaks on the inside of the cheeks - the gums, tongue, and lips may also be affected.
- The streaks are not usually painful or itchy.
- The white streaks are persistent (they do not go away).
- Possible redness and blistering of the gums.
- Sore mouth ulcers can develop and recur (erosive lichen planus).
- The patient's sense of taste may become blunted - some experience a metallic taste.
- Dry mouth.
- Spicy foods, crispy foods, and tomato products can exacerbate symptoms.
Symptoms of penile lichen planus (lichen planus of the penis)
- Purple or white ring-shaped patches appear around the glans (head of the penis).
- They are not usually itchy.
- Symptoms are similar to thrush, and often mistaken for thrush.
Symptoms of lichen planus of the vagina and vulva
Vulva - white streaks develop, similar to those that appear in the mouth. They are usually not itchy or painful. The skin may be red. Erosive lichen planus may affect the inner lips (labia minora) and the entrance to the vagina (introitus) - the affected mucous membrane is bright red and raw. The labia minora may shrink and stick to each other or to the labia majora (outer lips).
Vagina - may be red. Scar tissue may distort the shape of the vagina. Lichen planus can affect deeper within the vagina, causing desquamative vaginitis. A mucky discharge appears when the surface cells in the vagina peel off. The eroded vagina may easily bleed when touched. Sexual intercourse may become difficult or impossible.
Lichen planus follicaris (lichen planopilaris) - this affects hairy areas, such as the scalp. There may be redness and irritation. Sometimes there is hair loss, which can be permanent.
Other areas - lichen planus of the anus, ear canal, eyelids, and esophagus (all extremely rare). Erosive lichen planus is a chronic, painful condition that affects mucous membranes - mainly the mouth and the genitals.
Lichen planus: Risk factors and diagnosis
Antihistamines may be used to treat itching in severe cases of lichen planus.
Lichen planus can affect humans of any age or race. However, it is more common among:
- Middle-aged adults.
- Females (oral lichen planus).
- Patients with liver diseases, such as hepatitis C or cirrhosis.
After examining the skin and identifying the characteristic rash; a doctor may be able to diagnose lichen planus on visual examination.
Other forms of diagnosis include:
The doctor uses a circular tool to extract a small sample of the skin's deeper layers. Often, stitches are required to close the wound. The sample is examined under a microscope to confirm a lichen planus diagnosis.
If the doctor is still unsure, the patient may be referred to a skin specialist (dermatologist).
In the case of oral lichen planus - a dentist or oral specialist usually diagnoses oral lichen planus by taking a biopsy.
Lichen planus: Treatment options
Lichen planus is not a curable condition. However, when it affects the skin it usually clears within several months (sometimes it may take up to 2 years). Treatment focuses on easing symptoms until the rash clears.
Mild cases require no treatment by the doctor, except for periodic observations.
Treatment for severe cases of lichen planus may include:
- Antihistamines - to reduce itching.
- Phototherapy - with ultraviolet light.
- Topical medications (applied to the skin):
- Steroid creams or ointments - these can be very effective in reducing inflammation and redness. The medication is applied to the itchy spots. When the spots change color to brown or gray treatment should stop.
- Immunosuppressants - sometimes creams or ointments may contain a steroid-sparing immune-modulating medication (drugs to reduce the immune response).
- Oral corticosteroids (steroid tablets) - for more severe cases, or when creams and ointments are not effective enough.
- Cyclosporin capsules or acitretin tablets - these lower the immune system and may sometimes help. Only used in extreme cases.
- Oral symptoms - the doctor may prescribe steroid lozenges or mouthwashes if mouth ulcer symptoms are uncomfortable.
- Lichen planus of the mucous membranes - treatment is difficult to get right and may take years. The doctor may prescribe oral corticosteroids as well as topical corticosteroids.
Fortunately, oral lichen planus causes minimal problems and treatment is not usually required. Oral hygiene is sometimes poor among patients with pain inside their mouths, which makes it even more important to maintain good oral hygiene.
Complications of lichen planus
After the rash has gone, there may be permanent brown or gray marks on the skin - the darker the patient's skin, the more noticeable they will be. Persistent skin lesions and mouth ulcers may slightly raise the risk of developing cancer (rare).