Lichen Planus

The cause of lichen planus is not known with certainty. It may be an autoimmune response to one's own tissues, possibly triggered by a preceding viral infection (sometimes Hepatitis C) or a medication one is taking.

Lichen planus goes away on its own in up to two-thirds of people after about a year. However, in some people, it may last for many years. Lichen planus most commonly occurs in the 30-60 year old age group.

Symptoms of lichen planus may include:

• reddish-purplish, scaly patches or flat topped bumps on the wrists, lower back, and shins
• intense itching
• lace-like white lesions in the mouth or on the mucosal surfaces of the genitals may occur; sometimes these are painful
• the lichen planus lesions frequently occur in areas of scratching or other skin injury

Lichen planus is thought to be an autoimmune response that may be triggered by a preceding viral infections or by a medications, such as:

• gold salts (i.e., Myochrysine)
• captopril (i.e., Capoten)
• enalapril (i.e., Vasotec)
• labetalol (i.e., Trandate)
• hydroxychloroquine (i.e., Plaquenil)
• chloroquine (i.e., Aralen)
• hydrochlorothiazide (i.e., Esidrix, HydroDIURIL, Microzide, Oretic, HCTZ)
• propranolol (i.e., Inderal, InnoPran)
• penicillamine (i.e., Cupramine)
• quinidine

No means of preventing lichen planus is known at this time. Avoiding certain medications may reduce flare-ups in someone with this disorder.

A thorough history and physical examination of the skin and the inside of the mouth is recommended. The distinctive appearance of the skin and mouth lesions may confirm lichen planus.

A biopsy of the lesion may be done if necessary. A skin biopsy is the surgical removal of a small piece of affected skin. The sample is then examined under a microscope by a pathologist, dermatopathologist or dermatologist.

Skin lesions of lichen planus that persist may occasionally be associated with hair loss and complete nail loss.

Lichen planus is not contagious and poses no risks to others.

If symptoms of the lichen planus are mild, no treatment may be needed as it is expected to gradually clear up over time.

Treatment of lichen planus may include:

• antihistamines to reduce the itching
• liquid lidocaine (i.e., Xylocaine) mouthwashes to numb the affected areas
• topical immunomodulator (such as tacrolimus) in oral lichen planus
• topical corticosteroid creams or ointments
• corticosteroid injections directly into the skin lesions
• oral corticosteroids, such as prednisone
• ultraviolet light therapy

Side effects depend on the specific medications used but may include drowsiness and allergic reactions. Long-term use of oral corticosteroids can thin the bones, producing fracture risk, lower resistance to infection, and predispose to diabetes.

The skin lesions of lichen planus may clear up completely with treatment. Recurrence of lichen planus is likely when treatment is discontinued. Also, the degree and severity varies with each occurrence.

A relationship between LP and squamous cell malignancy has been suspected by some experts, but is uncertain. Another skin condition, lichen sclerosis, is associated with skin cancers 4 to 5 percent of the time.

Lichen planus is monitored with physical examination at regular intervals. Any new or worsening symptoms should be reported to the healthcare professional.