Lichen Planus - Causes, Symptoms and Treatment

Definition

Lichen Planus is a common inflammatory disease of the skin and mouth. It affects about one to two percent of the general population. The name lichen refers to the lichen plant which grows on rocks or trees, and planus means flat. Lichen planus is a relatively common skin disease that comes in episodes lasting months to years. The onset may be gradual or quick, but its cause, like many skin diseases, is unknown. It appears to be a reaction in response to more than one provoking factor. The most common areas are the inner wrists, the forearms and the ankles. Lichen planus may also affect the scalp, the nails or the inside of the mouth. On the scalp, lichen planus may cause hair loss. Lichen planus of the nails can cause brittle or split nails. More than two thirds of patients are aged 30-60 years. However, it can occur at any age.

Causes

1. The exact cause is unknown, but the disorder is likely to be related to an allergic or immune reaction.
2. Lichen planus may occur by allergic reaction of non-steroidal, anti-inflammatory drugs, iodides, tetracyclineetc, streptomycin and hydrochlorothiazide etc.
3. It may also cause by different metals including gold, bismuth, arsenic or antimony etc.
4. It may also be caused by dental fillings containing mercury in the form of amalgam and rough fillings.
5. Age may also be an important cause in this disease. Lichen planus generally affects middle age adults. It is less common in children.

Symptoms

1. In lichen planus itching may be present. Itching is mild to severe.
2. The lesions are violet colored.
3. The lesions may present in flat-topped, bumps or patches discrete or in clusters.
4. They may be present on the flexor surfaces of the wrists and on the penis, lips, tongue, and mouth mucous membranes. Lichen planus has been reported in the genital and anorectal areas.
5. The lesions may be about 0.8 to 1.5 inches (2 to 4 centimeters) in diameter.
6. Lesions on the legs are generally darker in appearance and thick patches can form on the shins. Rarely, blisters may form in the lesions. When the scalp is involved, permanent hair loss may result.
7. Lichen planus lesions may also affect the nails on the hands or the feet. In most cases, only a few nails are affected.
8. Patients with lichen planus are sometimes tense and nervous, and episodes of dermatitis may be temporarily related to emotional crises.

Treatment

1. It is usually mild and may require no treatment. Treatment generally concentrates on reducing the itching and inflammation
2. Topical tretinoin cream applied to mucosal lichen planus followed by topical corticosteroid cream may be beneficial.
3. Psoralens plus long-wave ultraviolet light can also be effective for chronic lichen planus.
4. In extensive cases systemic steroids such as prednisone may be prescribed for a few weeks or longer. Systemic steroids may have serious side effects, so discuss this treatment with your dermatologist.
5. Other treatments include long term antibiotics, oral antifungal agents, phototherapy, acitretin, methotrexate and hydroxychloroquine.