Lichen Planus

Lichen planus presents with the development of purple colored pruritic rash with flat tops. In many cases, the rashes have lacy white lines running through them known as Wickham’s striae. The rashes most commonly develop on the wrists, ankles and lower back. However, they can occur almost in any area of the body. In addition, LP may cause dry mouth, nail abnormalities, loss of hair and development of metallic taste in mouth.

Lichen planus often develops at the site of skin injury and may appear as a single lesion or in clusters. The lesions gradually increase in size and can sometimes turn painful [6].

A preliminary physical examination of the rash is enough to diagnose lichen planus. In addition, various other tests may also be required to confirm the condition. These include:

• Laboratory studies such as the direct immunofluorescence study which shows presence of globular deposits of IgM along with apoptotic keratinocytes.
• Skin biopsy is also necessary to rule out associated skin diseases.
• Blood tests are also conducted to look for hepatitis.

Lichen planus cannot be cured; the symptoms can however be well managed with appropriate treatment regime which includes [7]:

• Antihistamines are prescribed if the rash has developed due to allergic reactions.
• Corticosteroid creams are employed to be applied on the rash to relieve redness and swelling [8].
• PUVA therapy is a kind of light therapy employed to treat skin rashes.
• Retinoic acid is a medication which can either be taken orally or can be applied on the rash.
• Lidocaine mouthwashes are prescribed when LP has developed inside mouth.
• Other topical ointments such as tacrolimus and pimecrolimus are employed to be applied on the rashes [9].
• Oral metronidazole and acitretin have proved to be effective against lichen planus [10].

The prognosis of lichen planus is quite favorable if treatment is initiated on right time. The rash usually clears up within 18 months; however individuals may continue to experience recurrent attacks of LP for several years. In conditions when allergic reactions to certain medications causes LP then the rash gets corrected once the medication is stopped.

Lichen planus is thought to be an autoimmune disease. The particular factor that causes the immune system to behave in such a fashion is unknown. However, certain risk factors have been identified to play a role in causation of LP. These include viral diseases such as hepatitis C, exposure to certain medications, chemical and dyes. All these factors can predispose an individual to develop lichen planus. Medications that are taken for treating blood pressure and heart disease can trigger an attack of LP [2].

The exact incidence of lichen planus is unknown. With the available data it can be stated that about 1% of new patients at health care clinics suffer from LP in the United States. Some reports point towards the fact that LP occurs more frequently during the months of December and January. Such a type of skin disorder is more common in individuals aged 40 years and above [3].

Certain types of disease condition of altered immunity are known to trigger the development of lichen planus. Such type of disease conditions include vitiligo, ulcerative colitis, dermatomyositis, myasthenia gravis, lichen sclerosis and alopecia areata.

Researchers have pointed towards a strong link between lichen planus and hepatitis C, primary biliary cirrhosis and chronic active hepatitis. Statistics have shown that about 16% patients with lichen planus also suffered from hepatitis C virus infection. This in turn indicates that individuals with liver anomalies fall easy prey to LP [4].

Stress is yet another factor that is known to trigger attacks of LP. It either aggravates the existing condition or induces the development of characteristic skin rashes [5].

So far there are no guidelines to prevent the development of lichen planus. Individuals allergic to certain medications can avoid the use of such drugs to prevent development of rashes.

Lichen planus (LP) cannot be cured, but can be well managed with an appropriate treatment regime. Symptoms are gradually brought under control with medications and therapies. Lichen planus is a non–infectious skin disease and the rash develops in the areas of arms, legs, trunk, mouth, nails, scalp, vulva, vagina and penis [1].

Lichen planus is not a serious condition; however, in some rare cases, the rashes may itch and certain types of this skin condition can give rise to serious and debilitating symptoms. Middle aged populations are most affected by this skin disorder.

Definition

Lichen planus is defined as the development of itchy skin rashes on the skin. It is a chronic skin condition with no cure. The symptoms can be managed with appropriate treatment regime. In rare cases, the symptoms may exacerbate and turn serious. Individuals tend to get recurrent bouts of lichen planus.

Cause

The exact cause of lichen panus is not known. It is thought to occur due to allergic reaction or immune response to certain conditions. Research has also proved that certain underlying disease conditions such as hepatitis C, primary biliary cirrhosis and chronic active hepatitis. Stress has also been identified as a potential risk factor for development of lichen planus.

Symptoms

The rashes manifest as round shaped purple colored lesions having sharp borders. In many cases, the lesions may get covered with white marks or lines known as Wickham’s striae. The rashes may develop as a single lesion or may in multiple numbers. The rashes turn itchy and painful making conditions worse for the affected individuals.

Diagnosis

Diagnosis of lichen planus is done through a preliminary physical examination of the rash. In addition, blood tests are carried out to asses liver functioning. Skin biopsy may also be required to rule out associated disorders.

Treatment

There is no absolute cure for lichen planus. The condition can be managed with appropriate medications and topical ointments. In many instances, light therapy has been found to be helpful in treatment of lichen planus. Fluorinated topical steroids are helpful for treating mild symptoms. More severe forms may require a rigorous treatment regime. When rashes have developed inside the mouth, then individuals are given lidocaine mouthwashes to relieve the symptoms.

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