Lichen planus is a chronic inflammatory condition affecting the skin, mucous membranes, hair, and nails. It manifests as purplish, itchy, flat-topped bumps on the skin and lacy white patches or painful sores in the mouth and genital areas. While the exact cause remains uncertain, it is believed to involve an abnormal immune response. Lichen planus is not contagious.
Symptoms and Clinical Manifestations
Cutaneous Lichen Planus
Cutaneous lichen planus presents with:
- Purple, flat-topped papules: Commonly appearing on the inner forearms, wrists, and ankles.
- Itching: Often intense and discomforting.
- Koebner phenomenon: Development of new lesions along lines of trauma or scratching.
- Residual hyperpigmentation: Affected skin may remain darker even after lesions heal.
Oral Lichen Planus
Oral lichen planus affects mucous membranes inside the mouth, with two main types:
- Reticular form: Characterized by white, lacy patches, typically asymptomatic.
- Erosive form: Manifests as red, swollen tissues or open sores, causing burning sensations or pain.
Lesions commonly appear on the inner cheeks, gums, tongue, inner lips, and palate. Mayo Clinic
Genital Lichen Planus
In females, genital lichen planus can cause pain, burning, and discomfort during intercourse, often presenting as red, eroded areas or white patches. In males, it may affect the penis and scrotum, leading to similar discomfort.
Nail and Scalp Involvement
Lichen planus can affect the nails, resulting in ridges, thinning, splitting, or even nail loss. Scalp involvement may lead to hair loss, which can be permanent if not treated promptly.
Causes and Risk Factors
The precise cause of lichen planus is not well understood but is thought to involve an abnormal immune response where the immune system attacks skin or mucous membrane cells. Potential triggers include:
- Hepatitis C infection
- Certain medications: Pain relievers and other drugs.
- Allergic reactions: To metals in dental fillings.
Risk factors include middle age and, for oral lichen planus, being female.
Diagnosis
Diagnosis is based on clinical examination and may be confirmed through:
- Biopsy: Microscopic examination of affected tissue.
- Blood tests: To rule out conditions like hepatitis C.
- Allergy tests: If an allergic reaction is suspected.
Treatment Options
While mild cases may not require treatment, options for managing symptoms include:
- Topical corticosteroids: To reduce inflammation and itching.
- Oral corticosteroids: For severe cases.
- Antihistamines: To alleviate itching.
- Phototherapy: Exposure to specific wavelengths of light.
Regular monitoring is essential, especially for oral lichen planus, due to a slight increased risk of oral cancer.
Lifestyle and Home Remedies
Self-care measures can help manage symptoms:
- Lukewarm baths: Adding oatmeal-based products can soothe skin.
- Cool compresses: Applying damp cloths can reduce itching.
- Over-the-counter hydrocortisone: Use creams with at least 1% hydrocortisone for mild symptoms.
- Oral hygiene: Brushing teeth twice daily and flossing can help manage oral lichen planus.
Complications
Potential complications include:
- Chronic discomfort: Persistent itching or pain.
- Scarring: Especially in genital or scalp involvement.
- Oral cancer: Slightly increased risk with oral lichen planus.
- Hair and nail loss: Potentially permanent if untreated.
Regular follow-up with healthcare providers is crucial to monitor and manage these risks.
Visual Representation of Affected Areas
This diagram illustrates the various areas affected by lichen planus and their associated manifestations.
lichen planus is a multifaceted condition requiring individualized management strategies. Early diagnosis and appropriate treatment are essential to alleviate symptoms and prevent complications.
