What is lichen planus?
Lichen planus is a non-infectious, itchy skin rash that is triggered by the immune system. It is not known why such abnormal immune response happens.
Who gets lichen planus?
Anyone can get lichen planus. It is most common in middle-aged adults. Women get lichen planus in their mouths more often than men do.
Why do you get it?
The exact cause is not known. It is said to be an autoimmune disease where the body’s immune system becomes overactive, causing an excess amount of proteins to be produced, which inflame the skin leading to itchy bumps over the skin.
It can also occur as a reaction to certain medications like: gold injections, antimalarial tablets, and certain group of drugs like antihypertensive & anti psychiatric medicines. Sometimes mercury dental filling can cause lichen planus in the oral mucosa. Infections due to bacterial or viral infections like hepatitis C virus and hepatitis B virus can trigger lichen planus. Sometimes Insect bites like tick or leech bites can trigger lichen planus.
How does it appear?
It affects the skin, nails, scalp and the mucosa like mouth and genitalia
On the skin it occurs as itchy reddish violaceous bumps over the wrists, lower back, and ankles, but they can appear anywhere on the skin, including the genitals.
These bumps sometimes disappear on its own & appear in other places. These bumps itch very badly so that due to continuous scratching they become dark & thick bumps. These bumps slowly fade away leading to dark spots which lasts for many months.
Lichen planus appears inside the mouth (insides of cheeks), as patches of tiny white dots and lines that can look like lace. Over the gums & tongue it appears as swollen, reddish painful sores (can hurt or burn).
Lichen Planus on the genitalia, appears as whitish small bumps with redness & soreness.
Lichen Planus can affect the nails appearing as ridges or grooves, splitting or thinning of nails.
Types of Lichen Planus:
- Generalized Lichen Planus:
Here multiple itchy bumps appear all over body including, arms, legs, lower back.
- Lichen Planus Hypertrophicus:
Here itchy bumps over legs become large thick dark bumps due to constant scratching. This type of Lichen planus lasts for many years.
- Actinic Lichen Planus:
Here violaceous/reddish itchy bumps appear over sun exposed areas like arms, neck, face.
- Segmental Lichen Planus:
Here violaceous/reddish itchy bumps appear on one side of the body in a linear fashion
- Lichen Planus Pigmentosus:
Here skin over the face, neck, upper arms become violaceous to dark slate blue colour with or without itching. Commonly seen in women. Skin becomes darker due to sun exposure.
- Lichen Planus Planopilaris:
Here lichen planus can affects the scalp as redness and irritation of scalp, tiny bumps, leading to thinning of hairs leading to permanent bald patches.
General information:
It is not contagious, not hereditary, not harmful for health, except very itchy. Long standing Lichen Planus Hypertrophicus can become malignant if not treated properly.
How long will it continue?
Skin lesions tend to clear within a couple of years in most people.
Spontaneous recovery is unpredictable, and lichen planus may recur at a later date under stressful conditions.
What are the aggravating factors?
Mental Stress
Scratching
Smoking
Certain drugs
Infections
Insect bites
Treatment:
It is a controllable condition.
Oral medications: Immunosuppressants like Methotrexate, Cyclosporine, Steroids are the drug of choice to control this disease. Antihistamines are given to reduce itching. Oral Antibiotics are given for infections.
Topical medications: Topical steroids, Calcipotriol, Tacrolimus oints are the drug of choice to be taken under doctor’s supervision
Phototherapy with Ultraviolet A or B rays helps to control the itching & the bumps.
General measures:
Limit stress. Balanced diet, improving in lifestyle habits, exercises, yoga meditation helps a lot.
Avoid scratching
Avoid injuries
Stop smoking, alcohol