Lichen planus The name "lichen" refers to the lichen plant which grows on rocks or trees, and "planus" means flat. It is a common inflammatory disease that usually affects the skin and mucosa of mouth and genitals. It causes inflammation, itching, and distinctive purplish hue colour in the skin lesions. It is not an infectious disease, it does not appear to be inherited, and it is not related to nutrition. It affects about one to two percent of the general population. The dermatologist suspects lichen planus based on the distinctive appearance of the lesions and sometimes a skin or mouth biopsy is needed to confirm the diagnosis. The skin lesions are classically purple, plane topped, polygonal, papules, extremely pruritic occurring generally first around the ankles, wrist,lower back but can involve the whole body. Lichen Planus of the mouth most commonly occurs inside the cheeks, but can affect the tongue, lips, and gums. Oral Lichen Planus is more difficult to treat and typically lasts longer than the skin. About one in five people who have oral lesions also have skin lichen planus. Nail changes have been observed in Lichen Planus. The majority of nail changes results from damage to the nail matrix, or nail root and can lead to total dystrophy and destruction of the nail.
The goal of treatment is to reduce the symptoms and speed healing of the skin lesions. If symptoms are mild, no treatment may be needed.
Treatments may include: Antihistamines (anti-allergic medicines), If one has mouth lesions, lidocaine mouth washes may numb the area temporarily and make eating more comfortable. Topical corticosteroids (such as triamcinolone acetonide cream) or oral corticosteroids (such as prednisone) may be prescribed to reduce inflammation and suppress immune responses. Corticosteroids may be injected directly into a lesion also. Topical retinoic acid cream (a form of vitamin A) and other ointments or creams may reduce itching and inflammation and may aid healing. Occlusive dressings may be placed over topical medications to protect the skin from scratching. A specific form of ultraviolet light treatment called PUVA may be needed in selective cases.
Lichen Planus of the skin is characterized by reddish-purple, flat-topped bumps that may be very itchy. Some may have a white lacy appearance called Wickham's Striae. They can be anywhere on the body, but seem to favor the inside of the wrists and ankles.
Lichen planus is generally not harmful and may resolve with treatment, but it can persist for months to years. Oral lichen planus usually clears within 18 months. Patients with oral lichen planus (mouth ulcers) may be at a slightly increased risk of developing oral cancer. Because of this risk I recommend discontinuing the use of alcohol and tobacco products, which also increase the risk and also to have regular visits to the dermatologist, every six to twelve months - for oral cancer screening. Spicy foods, citrus juices, tomato products, caffeinated drinks like coffee and cola, and crispy foods like toast and corn chips can aggravate Lichen Planus especially if there are open sores in the mouth.