Lichen Planus

FLichen planus 

Lichen planus is a disease that causes inflammation (swelling and irritation) on skin or inside mouth. Lichen planus causes a rash that is usually itchy. Inside mouth, it may cause burning or soreness.

 

Recommended treatment duration is 1-3 years. 

Depend upon the chronicity of lichen planus and severity also.

Expectation is gradual betterment in discomfort, itching and other symptoms. 

Post inflammatory hyperpigmentation is difficult to go.

 

 Cause

• Hepatitis C, a virus that attacks liver.
• Certain medicines such as high blood pressure, diabetes, heart disease, and malaria medications.
• Reactions to metal fillings in teeth.
• An autoimmune reaction, the body's own defense system act against body.

 

Diagnosis

Clinical presentation of lesions helps in diagnosing lichen planus, based on the changes on skin or in mouth. For confirmation of the diagnosis, need a biopsy. 

 

Symptoms

        Skin: there are shiny red or purple eruptions. These eruptions are firm and may itch a little or a lot. Fine white lines or scales may accompany the bumps. Location are wrists, arms, back, and ankles. Thick scaly patches may appear on shins and ankles. Sometimes, bumps on skin may appear in an area where skin has been scratched or burned. Dark skin patches may replace skin bumps. These patches are difficult to get fade.

• Mouth: Lichen planus inside mouth looks like lacy patches of tiny white dots. These patches may occur on the inside of cheeks or on tongue. In severe cases, redness, burning and sores develop.
• Nails: Appear on a few, or all fingernails and toenails. Thinning, ridges, splitting, and nail loss.
• Scalp: Redness, irritation, and minute eruptions can form on scalp. In few cases, hair thinning and scarring can develop.
• Genitals: Lichen planus in genitals can cause bright red, painful areas.

 

 Types

Skin

The most common type of lichen planus affects the skin. It takes weeks for lesions to appear and spread.

After the rash is gone, the skin in the affected area may look hyperpigmented.

Oral

looks like lacy patches of tiny white dots. These patches occur on the inside of cheeks or on tongue. In severe cases, redness and sores develop.

Besides the skin, mouth, or genitals, lesions can occur in other areas. These may include:

• mucous membranes (such as the esophagus)
• nails
• the scalp

 Causes 

Lichen planus develops when body attacks skin or mucous membrane cells by mistake. There’s evidence genes and environmental factors may play a role.

Genetics

Specifically, lichen planus can run in families and certain immune system cells are linked to the condition.

Viral infection

Lichen planus may also be triggered by a viral infection.A study found there’s a link between hepatitis C infection and chronic inflammatory skin disease.  Certain types of herpes viruses, may also cause lichen planus.

Environmental factors

Certain environmental factors may also cause the condition, including metal dental fillings and some medications.

 

Risk factors

Lichen planus can occur in anyone, at any age.

The oral form is common in females although the skin form of lichen planus prevalent in both sexes equally. Most common age is middle-aged people.

Positive history of family members who’ve had lichen planus, having a viral disease like hepatitis C, or being exposed to certain chemicals that trigger the condition. These triggers may include:

• other medications
• antibiotics
• metals, like mercury and copper

Testing

• a biopsy which means taking a small sample of skin cells to view under a microscope.
• an allergy test to find out if having an allergic reaction.
• liver function tests, including a test for hepatitis C.

 

Complications 

Lichen planus can be difficult to treat if it develops on vagina or vulva. This can lead to pain, scarring, and discomfort during sex.

The condition can also cause discoloration of the skin, wherever it appears on the body.

Developing lichen planus can also increase risk of carcinoma. 

People with erosive lichen planus are also at risk for skin infections.

 Treatment 

Homeopathic medications.

Counselling and educating about the disease.

Required dos and don'ts. 

Dietary advice and restrictions if any.