What Is Lichen Planus?
Lichen planus is an uncommon immune-related condition that causes red, purple, or white spots to form on the skin. It may accompany other illnesses that affect the immune system, such as
- ulcerative colitis,
- alopecia areata,
- vitiligo,
- lichen sclerosis, and
- myasthenia gravis.
Lichen planus can occur anywhere on the body, including
What Are Symptoms of Lichen Planus?
The main symptom of lichen planus is shiny, flat, red, purple, or white spots on the skin.
- Spots often develop on the parts of the skin that touch when joints are bent (flexural surfaces of the limbs) such as wrists, arms, or legs
- Lesions may itch
- As spots heal, they may cause dark spots on the skin
- Lesions on the mucous membranes (such as the lining of the inside of the mouth, the vagina, and other organs) may cause pain, or a burning sensation, or patterns that look like white lace
- Lichen planus that affects the mouth can make it difficult to eat
- Lines or ridges may form on the nails
What Causes Lichen Planus?
The cause of lichen planus is unknown, although it is related to immune response and inflammation.
A rare type of lichen planus, familial bullous lichen planus, may have a genetic cause.
Triggers for lichen planus may include:
- Certain medications
- Antimicrobials
- Antihistamines (H2-blockers)
- Antihypertensives/antiarrhythmics such as ACE inhibitors and beta-blockers
- Antimalarial drugs
- Antidepressants/antianxiety drugs/antipsychotics
- Anticonvulsants
- Diuretics
- Antidiabetics
- Metals
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Proton pump inhibitors (PPIs)
- Lipid lowering drugs
- Tumor necrosis factor-alpha antagonists
- Monoclonal antibodies
- Metal dental fillings (oral lichen planus)
- Stress
- Infection, such as hepatitis C virus infection
How Is Lichen Planus Diagnosed?
Frequently, cutaneous lichen planus (on the skin) can be diagnosed on visual examination. In some cases, a skin biopsy may be indicated to confirm the diagnosis.
Other tests that may be performed include:
- Direct immunofluorescence studies may be performed in patients with bullous lesions to rule out other types of autoimmune blistering diseases
- Screening for hepatitis C virus infection
- Testing for Candida infection for oral lichen planus
- Pelvic examination for penile or vulvar lichen planus on the genitals
- Dermoscopy of the scalp (trichoscopy)
What Is the Treatment for Lichen Planus?
Lichen planus usually goes away within 12-18 months. In about 20% of patients the condition will recur and it may linger for years, especially oral lichen planus.
Treatments for lichen planus include:
- Topical steroids as first-line treatment such as betamethasone topical (Diprolene, Celestone, Luxiq) and halobetasol (Ultravate, Halonate) for cutaneous lichen planus (skin)
- Systemic steroids such as triamcinolone (Aristospan, Kenalog)
- Retinoid-like agents such as isotretinoin (Amnesteem, Claravis, Myorisan, Sotret), tretinoin topical (Retin-A, Avita, Renova, Atralin, Tretin-X), and acitretin (Soriatane)
- Immunosuppressants such as cyclosporine (Sandimmune, Neoral, Gengraf)
- Other drugs: metronidazole (Flagyl), methotrexate (Rasuvo, Otrexup), hydroxychloroquine (Plaquenil), griseofulvin (Gris-Peg), and sulfasalazine (Azulfidine)
- Topical calcineurin inhibitors such as tacrolimus (Prograf) and pimecrolimus (Elidel) for lichen planus of the oral mucosa
- Antihistamines for itching
Treatment for widespread lichen planus may include:
How Do You Prevent Lichen Planus?
If triggers for lichen planus are identified, then avoiding those triggers may prevent recurrent episodes.
If it is related to a medication you take, you may need to change the medication or the dose. (Do not stop taking any medication without first talking to your doctor.)
If lichen planus is suspected to be due to hepatitis C infection, then that condition needs to be treated.
