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Lichen planus

Causes, symptoms and treatment

Lichen planus is an autoimmune and inflammatory condition of the mucous membranes, skin, hair and nails. On the skin, it usually appears as purplish and itchy, flat-topped vesicles developing over several weeks. In the areas covered by a mucous membrane like mouth and vagina, lichen planus appears as lacy white patches, often associated with painful sores. According to the American Skin Association (ASA), lichen planus affects around 1-2% of Americans and 1-3% of the general population. It typically involves people over the age of 30 years.

Symptoms

The symptoms and signs of lichen planus may vary depending on the areas affected. However, typical ones include:

  • Purplish or lacy white patches, flat-topped vesicles, most often on the wrist, ankle and inner forearm, but sometimes on the body parts covered by mucous membranes like mouth and external genitals.
  • Itching
  • Blisters that may break to form crusts or scabs
  • Painful oral or vaginal ulcers
  • Lacy white patches in the mucous membrane of the mouth (on the gums, lips or tongue or inside the cheek).
  • Nail damage or loss
  • Hair loss and scalp discolouration

 Causes

Lichen planus occurs when the immune system mistakenly attacks your body own cells of the mucous membranes, skin, hair or nails. While this condition is something you will never truly be rid of, it can clear up for periods before flaring. It is not yet clear the exact cause of this abnormal immune behaviour. In some individuals, certain factors discussed below may trigger lichen planus.

  • Certain pigments, chemicals, and metals
  • Flu vaccine
  • Hepatitis C infection
  • NSAIDs or Nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen.
  • Certain medications for high blood pressure, heart disease, or arthritis

Treatment

Most individuals can manage mild cases of lichen planus at home, without specific medical care. When it affects the skin, it usually subsides by itself within several weeks to months. The treatment mainly focuses on relieving troublesome symptoms until the rash clears. If the condition causes significant itching or pain, you may need prescription drugs like acitretin tablets or cyclosporine capsules to reduce the hyperactivity of the immune system. Antihistamines are prescribed to regulate the inflammation and reduce itching to make the condition more tolerable. Another option you may be given on prescription are steroid creams or ointments, safe to use for a short period because of the steroid content or adverse reactions.

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