Lichen Planus

What is Lichen Planus?

Lichen Planus (LP) is a chronic inflammatory condition that affects the skin, mucous membranes (inside the mouth, genital areas), nails, and hair. It is characterized by itchy, purple-colored, flat-topped bumps on the skin or white, lacy patches in the mouth.

Causes

• The exact cause is unknown.

• Thought to be an autoimmune disorder where the immune system attacks skin and mucous membranes.

• Possible triggers include:

  • Viral infections (e.g., hepatitis C)

  • Certain medications (e.g., NSAIDs, beta-blockers)

  • Allergic reactions to dental materials

  • Stress

  • Genetic predisposition

Symptoms

Skin:

• Purplish, flat-topped, polygonal bumps

• Intense itching

• Commonly on wrists, ankles, lower back

• May show white, lace-like patterns called Wickham’s striae

Oral (Mouth) Lichen Planus:

• White, lacy patches on the inside of cheeks, gums, tongue

• Soreness or burning sensation

• Red swollen tissues or ulcers

Genital Lichen Planus:

• Painful sores or erosions

• Itching and discomfort

Nails:

• Thinning, ridging, or loss of nails

Scalp (Lichen Planopilaris):

• Hair loss and scalp inflammation

Types of Lichen Planus

1. Cutaneous LP — affects skin

2. Oral LP — affects the mouth

3. Hypertrophic LP — thickened, wart-like lesions, usually on legs

4. Annular LP — ring-shaped lesions

5. Lichen Planopilaris — affects scalp and hair follicles

6. Pigmented LP — dark patches, often after healing

7. Erosive LP — painful erosions, often oral/genital

Diagnosis

• Clinical examination of lesions

• Skin biopsy to confirm diagnosis

• Direct immunofluorescence test in some cases

• Blood tests to rule out hepatitis C or other triggers

Treatment

There is no cure, but symptoms can be managed.

Topical Treatments:

• Corticosteroid creams or ointments (to reduce inflammation and itching)

• Calcineurin inhibitors (e.g., tacrolimus)

• Mouth rinses for oral LP (e.g., corticosteroid mouthwash)

Systemic Treatments (for severe cases):

• Oral corticosteroids

• Immunosuppressants (e.g., cyclosporine, methotrexate)

• Retinoids (vitamin A derivatives)

• Antihistamines (for itching)

Other Measures:

• Avoid triggers such as certain medications or dental materials

• Good oral hygiene for oral LP

• Stress management

Prognosis

• Cutaneous LP often resolves within 1–2 years but may recur.

• Oral LP tends to be chronic and may persist for years.

• Rarely, oral LP can develop into oral squamous cell carcinoma, so regular monitoring is advised.

When to See a Doctor

• Persistent itchy skin lesions

• Painful mouth sores or ulcers

• Nail changes or hair loss

• Symptoms affecting daily life or worsening