Lichen Planus

What is Lichen Planus?

Lichen Planus is a chronic, inflammatory disorder. This can happen on your skin or inside your mouth. The causes of this condition are not completely known but some practitioners believe it can be due to Hepatitis C, adverse reaction to hypertensive, or malaria medications. It is also believed to be autoimmune, which means your body is attacking itself. 

What are the symptoms of Lichen Planus?

Signs and symptoms are dependent on the area affected. The lesions of Lichen Planus are known to follow “6 P’s”: Planar (flat), pruritic (itchy), papules, plaques, purple and polygonal. These lesions are most often seen on the inner forearms, wrist or ankle, and genitals.

Oral lichen planus usually presents with white lacy patches with open reddened sores. Oral lichen planus can also cause burning and pain. The open sores can be sensitive to acidic, hot, or spicy foods and can cause discomfort while speaking, chewing, or swallowing. The most common location for lichen planus to appear is the inside of the cheeks but it can also be seen in the gums, tongue, and palate. This condition mostly affects middle-aged women. 

What are the complications of Lichen Planus?

Since it is difficult to manage this condition in the genital areas, it can sometimes leave scars and cause sexual dysfunction as a long-term complication. Oral lichen planus can increase the risk of nutritional deficiency since it can be painful to eat. It can cause secondary fungal infections in the mouth and lastly even cause oral cancer. 

How is Lichen Planus diagnosed?

Your healthcare professional will mostly base their diagnosis on your history and symptoms. They can also perform a skin or oral mucosa biopsy to confirm their diagnosis. Since it is also known to be caused by Hepatitis C, your provider will test you for it by doing some blood labs. If the reaction is suspected to be allergic a patch testing could be performed as well. 

What are the differential diagnoses of Lichen Planus?

  • psoriasis
  • drug eruption
  • secondary syphilis 

How is Lichen Planus treated?

Since lichen planus is a chronic condition, there is not a cure for it. The treatment is mostly based on symptom management. The first method of treatment for lichen planus on the skin is a corticosteroid cream or ointment, if this doesn’t help then injection or oral medication might be recommended. Antihistamines such as Benadryl or Loratadine can be used to relieve the itching. Severe symptoms might require other medications that suppress your body’s immune system such as cyclosporine, methotrexate, or azathioprine.

Oral lichen planus can be treated with a corticosteroid mouthwash such as magic mouthwash. Topical numbing agents can be used to temporarily relieve the mouth pain. If there is no pain or discomfort and only the white lacy lesions are present then you might not need any treatment. Keep in mind that topical steroids can cause an overgrowth of yeast; therefore make sure to routinely follow up with your primary care provider. 
For more information about lichen planus, please visit the Johns Hopkins Medicine website.

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