Lichen Planus

Symptoms

Lichen planus symptoms vary depending on the part of the body affected. Several nails are usually impacted by the condition. Some common symptoms include:

• Flat, purple, shiny bumps, often on the wrists, inner forearms, or ankles
• Rash-like lines in areas where the skin has been scratched
• Lacy white spots on the inner cheeks or tongue
• Itching
• Painful lesions in the mouth or genital areas
• Hair loss (in rare cases)
• Nail loss or scarring
• Dark lines running from the tip to the base of the nail

Causes

Lichen planus is likely caused by the immune system attacking mucous membranes or skin cells. The exact cause of this abnormal immune reaction is unclear, and the condition is not contagious.

Possible triggers for lichen planus include:

• Hepatitis C infection
• Certain painkillers and other medications
• Allergic reactions to metal found in dental fillings

Risk Factors

While lichen planus can affect anyone, it is more common in middle-aged adults. Women are at a higher risk of developing lichen planus in the mouth compared to men.

Complications

Treating lichen planus in the vagina and vulva can be challenging and may result in intense pain and scarring. Lesions in the genital area can also make intercourse painful.

Even after recovery, the affected nails and skin may remain somewhat darker. Oral lichen planus can interfere with eating and increase the risk of developing oral cancer. In rare cases, the condition can affect the ear canal, potentially leading to hearing loss if left untreated.

Diagnosis

Your doctor will likely ask about your symptoms, review your medical history, and perform a physical examination to determine the underlying cause of your condition. Other diagnostic tests may include:

• Biopsy: A small tissue sample is taken from the affected area and examined in a laboratory to check for cell patterns associated with lichen planus.
• Blood tests: Blood samples may be taken to check for conditions linked to lichen planus, such as hepatitis C.

Treatment

If you do not experience any discomfort or pain, treatment may not be necessary. Lichen planus on the skin often resolves on its own within months or years.

However, medications and other treatments can help alleviate itching, reduce pain, and speed up the healing process. Discuss the pros and cons of various treatment options with your doctor. In some cases, you may need multiple approaches to effectively manage the symptoms.

Treating lichen planus affecting the nails or mucous membranes can be more difficult, and symptoms may recur even after successful treatment. Regular follow-up care, at least once a year, is recommended.

Corticosteroids

The first line of treatment for lichen planus affecting the skin is usually prescription corticosteroid creams or ointments, which help reduce inflammation, pain, and swelling.

If topical treatments are not effective or if the condition is severe or widespread, your doctor may prescribe corticosteroid injections or tablets. Side effects vary depending on usage, but corticosteroids are generally safe when used as prescribed.

Oral Medications

Other oral medications that may be prescribed for lichen planus include the antimalarial drug hydroxychloroquine or the antibiotic metronidazole.

Immune Response Medications

For severe cases, medications that modify the immune response may be necessary. While these drugs have shown some effectiveness, further research is needed. Options include:

• Azathioprine
• Cyclosporine
• Methotrexate
• Mycophenolate
• Sulfasalazine
• Thalidomide

Antihistamines

Oral antihistamines may help reduce skin itching triggered by lichen planus.

Light Therapy

Light therapy (phototherapy) can be effective in clearing lichen planus on the skin. In this treatment, the affected skin is exposed to ultraviolet B light two to three times a week for several weeks.

A potential side effect of light therapy is post-inflammatory hyperpigmentation, which can cause long-lasting changes in skin colour after healing.

Retinoids

Retinoid medications, taken orally or applied to the skin, are another treatment option for lichen planus. Acitretin is a commonly prescribed retinoid.

However, retinoids can cause birth defects, so they are not recommended for pregnant women or those planning to become pregnant. Your doctor may advise delaying treatment or choosing an alternative if you are pregnant or breastfeeding.

Managing Lichen Planus Triggers

If your doctor suspects that lichen planus is linked to an allergy, infection, medication, or other factors, additional tests or treatments may be necessary to address the underlying issue. This could involve changing your medication or undergoing further allergy testing.

Lifestyle and Home Remedies

Several self-care approaches can help relieve itching and discomfort caused by lichen planus:

• Bathe in lukewarm water with an oatmeal-based bath product, then rinse thoroughly, pat dry, and apply moisturiser.
• Apply a cold, moist cloth to the affected area.
• Use an over-the-counter hydrocortisone cream (1% strength), unless you're already using prescribed corticosteroids.
• Avoid scratching your skin or damaging your nails.
• Brush your teeth twice a day and floss daily if you have lichen planus in your mouth.

Alternative Medicine

Some small studies suggest that aloe vera gel may help with lichen planus of the vulva, while aloe vera mouthwash may be effective for oral lichen planus.

Additionally, managing stress through alternative approaches such as meditation may help as stress can exacerbate lichen planus symptoms.

Always consult your doctor before trying any alternative treatments, as some supplements or alternative therapies may cause adverse side effects.

Preparing for Your Appointment

You will likely start by seeing your GP. If lichen planus affects your skin, you may be referred to a dermatologist. If it affects the vulva or vagina, you may need to see a gynaecologist specialising in female reproductive health.

What to Do

Before your appointment, make a list of the following:

• Your symptoms and how long they have lasted
• Any medications, supplements, or vitamins you are taking, along with their dosages
• Key questions you want to ask your doctor

Some basic questions about lichen planus that you might want to ask include:

• What is the likely cause of my symptoms?
• Are there any other possible causes?
• Will I need any tests?
• How long will these skin changes last?
• What treatment options are available, and which do you recommend?
• What side effects might I experience from treatment?
• How can I manage my other health conditions along with lichen planus?
• Are there any restrictions I should follow?
• Do I need to see a specialist?
• Are there alternatives to the prescribed medications?
• Are there brochures or printed materials I can take home? Which reliable websites do you recommend for further information?

What to Expect from Your Healthcare Provider

During your appointment, your doctor may ask the following questions:

• Where on your body are the symptoms appearing?
• Are the affected areas painful or itchy?
• How would you rate the pain – mild, moderate, or severe?
• Have you recently started taking any new medications?
• Have you had any recent vaccinations?
• Do you have any known allergies?