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Lichen planus is a skin disease that also is common inside the mouth. It also can affect your genitals, scalp, fingernails
WHAT DOES LICHEN PLANUS LOOK LIKE?
On each part of the body, lichen planus looks somewhat different. The following describes what you can see on each part of the body.
On the skin, you will often see a few purplish shiny bumps. These bumps can be very itchy. People also see fine, white, lacy-looking lines on the bumps. If bumps continue to appear in the same place, thick patches of rough, scaly skin can develop. The most common places to have bumps are the wrists, lower back, and ankles.
Oral lichen planus can form on the gums, tongue and insides of the cheeks. Sometimes it affects the lips. It most often causes lacy white lines or raised white spots on the insides of the cheeks. A person also can have white patches.
Sometimes it can look like redness and swelling inside the mouth. Painful sores and ulcers also can develop. The mouth can feel tender or burn.
When lichen planus develops on the genitals, it causes the purplish bumps seen on the skin. Like the skin, these bumps can itch. Women get lichen planus on their external genitals and the mucous membrane that lines the vagina. The mucous membrane becomes red and raw. Like the skin, these bumps can itch and painful sores and scars can develop.
People who have lichen planus on their skin also may develop it on their nails. Sometimes more than one nail is affected. The affected nails lose their shine. They can split and thin. Grooves and ridges can appear. Nails can
darken, thicken, and separate from the nail bed. A nail may stop growing or fall off. While rare, a nail can disappear, permanently leaving the person without a nail.
This form of lichen planus is uncommon. It is called lichen planopilaris or LPP, and often begins with small bumps on the scalp. Redness, itch, and scaly patches can develop. The scalp may feel tender or burn. Some people see noticeable hair loss, which can be temporary or permanent if scarring develops.
WHO GETS LICHEN PLANUS?
Anyone can get lichen planus. It is most common in middle-aged adults. Women get lichen planus in their mouths more often than men do.
WHAT CAUSES LICHEN PLANUS?
The cause of lichen planus is not understood. Lichen planus is not a type of cancer, nor is it contagious.
Lichen planus might be an autoimmune disease. This means that the body’s immune system mistakes a part of the body as a foreign object. When this happens, the immune system starts to attack the skin, causing lichen planus.
Sometimes the immune system reacts this way because a medicine or a medical condition, such as an infection, triggers the reaction. If this is the reason for your lichen planus, an accurate diagnosis is essential. You may need to change medicine or treat the related medical condition.
There may be a link between lichen planus and infection with the hepatitis C virus. Many people with hepatitis C also have lichen planus. Your dermatologist may check to see whether you have this virus.
A prompt diagnosis and treatment are important for other reasons. Treatment can prevent the disease from worsening. When symptoms bother you, treatment can bring relief and speed healing.
HOW DOES A DERMATOLOGIST DIAGNOSE LICHEN PLANUS?
A dermatologist often can tell whether you have lichen planus by examining your skin, nails, and mouth. To make sure that you have lichen planus, a dermatologist may need to perform a biopsy. This is a medical procedure done in the dermatologist’s office that will remove a piece of skin to be examined under a microscope. Your dermatologist may call this a biopsy. Sometimes, you may need blood tests to rule out other diseases.
Your dermatologist also may ask what medicines you take. Some people develop an allergic reaction to a medicine. This reaction can look like lichen planus. If this happens, you may need to change medicines.
Your dentist may find lichen planus in your mouth during a checkup and encourage you to see a dermatologist. A very few people develop an allergic reaction to dental fillings that can look like lichen planus inside the mouth. If your dermatologist suspects this, you may need allergy testing.
HOW IS LICHEN PLANUS TREATED?
There is no cure for lichen planus. It often goes away on its own. Mild cases on the skin may not need treatment. Many cases of skin lichen planus go away within two years. About 1 in 5 people will have a second outbreak. In some people, lichen planus may come and go for years.
Lichen planus in the mouth often lasts longer than lichen planus on the skin. In the mouth, it can be harder to treat. Treatment is recommended for lichen planus of the mouth and genitals. If you have pain or a serious case, treatment is essential.
There is no U.S. Food and Drug Administration (FDA) approved treatment for lichen planus. The following treatment options may be offered by your dermatologist and may provide some relief:
- Topical (applied to the skin): Cream or ointment to reduce swelling, redness, and itch
- Oral (taken by mouth) or Injection: Pills (such as prednisone) or shots can help when lichen planus lasts a long time or a patient has many bumps or painful sores
- PUVA therapy: A type of light treatment that can help clear the skin
- Retinoic acid: Applied to the skin or given as a pill to help clear the skin
- Tacrolimus ointment or pimecrolimus cream: Commonly used to treat another skin problem, eczema, has also been shown to be beneficial in the treatment of lichen planus
Sometimes lichen planus can be stubborn. Your dermatologist may combine two or more treatments to help clear your signs and symptoms.
As lichen planus heals, it often leaves dark brown spots on the skin. These spots are harmless and may fade without treatment. If they do not, see your dermatologist for treatment options.
HOW DO I MANAGE MY LICHEN PLANUS?
- Follow your dermatologist’s advice on coping with lichen planus. Your dermatologist can help you control this common disease and feel
- Apply and take medicine as directed. While many people do not need treatment, if you received medicine to treat lichen planus, following directions and taking it as directed will increase the effectiveness of your
- If you have lichen planus on the skin, try not to scratch. Ask your dermatologist about ways to prevent
- If you have oral lichen planus,
• Limit tobacco and alcohol use or quit altogether.
Oral lichen planus increases your risk for oral cancer. If you smoke, chew tobacco, or drink, this increases your risk even more.
• Stop eating foods and drinking beverages that can worsen lichen planus in the mouth.
These include spicy foods, citrus fruits and juices, tomatoes and foods made with tomatoes, snacks that are crispy and salty, and drinks that contain caffeine.
A board-certified dermatologist is a medical doctor who specializes in diagnosis and treating the medical, surgical, and cosmetic conditions of the skin, hair and nails. To learn more about lichen planus or find a dermatologist in your area, visit aad.org or call toll free (888) 462-DERM (3376).
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Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides
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