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Lichen Planus

  • Lichen planus

Definition

Lichen planus is a skin disease of itchy, inflamed, reddish-purplish scaly patches and flat-topped bumps on the skin.

What is going on in the body?

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.

Risks

What are the causes and risks of the condition?

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

Prevention

What can be done to prevent the condition?

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

Diagnosed

How is the condition diagnosed?

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.

Long Term Effects

What are the long-term effects of the condition?

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

Other Risks

What are the risks to others?

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

Treatments

What are the treatments for the condition?

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

What are the side effects of the treatments?

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.

After Treatment

What happens after treatment for the condition?

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.

Monitor

How is the condition monitored?

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

Sources

Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998

Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000

The Merck Manual of Medical Information, 1997

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