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].

• Dentist

  RESULTS: In most cases, the dentist should be able to establish a correct diagnosis. [ncbi.nlm.nih.gov]

  See your doctor or dentist regularly. See your dentist twice a year for checkups and cleanings, or more often as directed by your dentist. [drugs.com]

  Your dentist or doctor may be able to make a diagnosis of oral lichen planus based solely on the appearance of your mouth. [moderndentistry.com.au]

• Weight Loss

  However, the patient was generally ill, with severe constitutional manifestations and marked weight loss. [jrheum.org]

  But I think that reducing the inflammation in my body, which is allowing my hormones to normalize, is a critical component of this weight loss (the real test will be if my weight drops below my lightest, which is only 2 pounds away now). [thepaleomom.com]

  Complications Severe cases of oral lichen planus may increase the risk of: Significant pain Weight loss or nutritional deficiency Stress or anxiety Depression Scarring from erosive lesions Secondary oral yeast or fungal infections Oral cancer Diagnosis [drugs.com]

  These lesions were very painful and produced a weight loss of 10 kg. since she wasn´t able to eat or use her dental prosthesis normally. She also had minor ulcerative lesions on the superior lip and genital mucosa. [scielo.isciii.es]

  Therefore, it is important to consider upper GI endoscopy particularly in LP patients with complaints of dysphagia, odynophagia, weight loss, or other esophageal symptoms and those with involvement of other mucosal surfaces [ 78 ]. Ocular LP. [hindawi.com]

• Falling

  Oral and vaginal lichen planus occur on the moist surfaces of the mouth and vagina, where inflammation caused by the disease often leads to surface skin layers falling off, leaving raw open areas. These erosions are very painful. [jamanetwork.com]

  Pain Relief Parkinsons Pediatrics & Maternity Physical Therapy Skin Care Winter Products Oxygen Hospital Supplies Shop by Topic Arthritis Pain Relief Assistive Technology Care for Your Feet Carpal Tunnel Syndrome Diet and Nutrition Emergency Supplies Fall [activeforever.com]

  This in turn indicates that individuals with liver anomalies fall easy prey to LP. Stress is yet another factor that is known to trigger attacks of LP. [symptoma.com]

• Nail Abnormality

  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. [symptoma.com]

  In most cases, the nail abnormalities improve spontaneously. Keywords: Trachyonychia, rough nails, twenty nail dystrophy How to cite this article: Gordon KA, Vega JM, Tosti A. Trachyonychia: A comprehensive review. [doi.org]

  Other Manifestations: OTHER LESIONS  Dry mouth  Hair loss  Metallic taste in the mouth  Ridges in the nails (nail abnormalities) 9. The goal of treatment is to reduce symptoms and speed healing. If symptoms are mild, it may not need treatment. [slideshare.net]

• Short Stature

  The treatment of TS differs according to age and Recombinant Human Growth Hormone (RHGH) therapy is usually given for the treatment of short stature in girls with TS in childhood. [ncbi.nlm.nih.gov]

• Aphthous Stomatitis

  BACKGROUND: In spite of all the efforts, recurrent aphthous stomatitis (RAS) and oral lichen planus (OLP) still have unexplained etiology. [ncbi.nlm.nih.gov]

  Lidia Gavic, Livia Cigic, Dolores Biocina Lukenda, Vladimir Gruden and Josipa Sanja Gruden Pokupec, The role of anxiety, depression, and psychological stress on the clinical status of recurrent aphthous stomatitis and oral lichen planus, Journal of Oral [doi.org]

  Furthermore, OLP seems to have a higher impact on patients’ quality of life than recurrent aphthous stomatitis but lower impact as compared to oral bullous diseases [ 280 ]. [hindawi.com]

  Immunopathogenesis of oral lichen planus and recurrent aphthous stomatitis. Semin Cutan Med Surg. 1997;16:284-94. [ Links ] 25. Sugerman PB, Satterwhite K, Bigby M. AutocytotoxicT-cell clones in lichen planus. [scielo.br]

• Eruptions

  Exposure to gold (commonly found in popular alcoholic schnapps liquors) and the metals found in photographic film development and processing have also caused a lichen planus–type eruption. [crutchfielddermatology.com]

  polymorphous light eruption, and erythema dyschronicum perstans. 5 The clinician also must exclude the possibility of a drug-induced photosensitive lichenoid eruption by taking a complete medication history. [cutis.com]

  Lichenoid drug eruption The cutaneous manifestations resemble idiopathic lichen planus. [en.wikipedia.org]

  Characteristic eruption consists of itchy, shiny, flat-topped violaceous papules and plaques favouring the extremities. [bestpractice.bmj.com]

• Skin Lesion

  White net-like patches or ulceration of mucous membranes, nail deformity, scarring alopecia, and other types of skin lesions may also occur. Most patients develop the disease between the age of 30 and 60 years. [bestpractice.bmj.com]

  Lymphocytic infiltration is evident in the lesions of lichen planus, and the direct irradiation of 308-nm excimer laser can induce apoptosis of the T lymphocytes in skin lesions, thereby has a unique therapeutic effect on the diseases involving T lymphocytes [ncbi.nlm.nih.gov]

  Erosive oral lesions and widespread itchy skin lesions often require the use of a systemic corticosteroid (e.g., oral prednisone). Unfortunately, skin lesions may return after systemic prednisone has been discontinued. [rarediseases.org]

• Dermatitis

  Table 1: Differentiating features between lichen planus pigmentosus and erythema dyschromicum perstans Click here to view Pigmented contact dermatitis/Riehl's melanosis Pigmented contact dermatitis (PCD) is noneczematous variant of contact dermatitis [pigmentinternational.com]

  RESULTS: Eighty-three patients with PP and 86 patients with either dermatitis, LP or PR were included in the study. [ncbi.nlm.nih.gov]

• Alopecia

  White net-like patches or ulceration of mucous membranes, nail deformity, scarring alopecia, and other types of skin lesions may also occur. Most patients develop the disease between the age of 30 and 60 years. [bestpractice.bmj.com]

  Graham-Little-Piccardi-Lassueur syndrome is the triad of cicatricial alopecia of the scalp, nonscarring alopecia of the axilla, groin, or eyebrows, and perifollicular hyperkeratotic papules. [clinicaladvisor.com]

  White net-like patches or ulceration of mucous membranes, nail deformity, scarring alopecia, and other types of skin lesions may also occur. Most patients develop the disease between ages 30 and 60 years. [online.epocrates.com]

  A scarring alopecia may result. A variant of lichen planopilaris is frontal fibrosing alopecia. [emedicine.medscape.com]

• Pruritus

  Hypertrophic lichen planus (HLP) is a variant of lichen planus characterized by marked epidermal hyperplasia and severe pruritus. [ncbi.nlm.nih.gov]

  Introduction Lichen planus may be self-limited or chronic and presents as localized or generalized disease, usually with mild to severe pruritus. [derm101.com]

• Genital Lesions

  Oral and genital lesions can develop, become chronic, and cause morbidity. Diagnose LP by clinical appearance and, if necessary, biopsy. Treat localized LP with topical or injected corticosteroids. [msdmanuals.com]

  Besides the skin, mouth, or genitals, lesions can occur in other areas. These may include: mucous membranes (such as the esophagus) nails the scalp But lesions in these areas are less common. [healthline.com]

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.

1. Wagner G, Rose C, Sachse MM. Clinical variants of lichen planus. J Dtsch Dermatol Ges 2013; 11:309.
2. Bigby M. The relationship between lichen planus and hepatitis C clarified. Arch Dermatol. Sep 2009;145(9):1048-50.
3. Lehman JS, Tollefson MM, Gibson LE. Lichen planus. Int J Dermatol 2009; 48:682.
4. Chuang TY, Stitle L, Brashear R, Lewis C. Hepatitis C virus and lichen planus: A case-control study of 340 patients. J Am Acad Dermatol. Nov 1999;41(5 Pt 1):787-9.
5. Manolache L, Seceleanu-Petrescu D, Benea V. Lichen planus patients and stressful events. J Eur Acad Dermatol Venereol. Apr 2008;22(4):437-41.
6. Scully C, el-Kom M. Lichen planus: review and update on pathogenesis. J Oral Pathol 1985; 14:431.
7. Cribier B, Frances C, Chosidow O. Treatment of lichen planus. An evidence-based medicine analysis of efficacy. Arch Dermatol. Dec 1998;134(12):1521-30.
8. Thongprasom K, Dhanuthai K. Steriods in the treatment of lichen planus: a review. J Oral Sci 2008; 50:377.
9. Radfar L, Wild RC, Suresh L. A comparative treatment study of topical tacrolimus and clobetasol in oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105:187.
10. Rasi A, Behzadi AH, Davoudi S, Rafizadeh P, Honarbakhsh Y, Mehran M, et al. Efficacy of oral metronidazole in treatment of cutaneous and mucosal lichen planus. J Drugs Dermatol. Oct 2010;9(10):1186-90.