Lichen planus

Lichen planus | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Lichen planus Lichen planus About lichen planus Symptoms of lichen planus Causes of lichen planus Diagnosing lichen planus Treating lichen planus Complications of lichen planus About lichen planus Lichen planus is a non-infectious, itchy rash that can affect many areas of the body. Affected areas caninclude the: arms, legs and trunk mouth (oral lichen planus) nails and scalp vulva, vagina and penis The exact cause of lichen planus is unknown. However, the condition isnt infectious and doesnt usually run in families. It cant be passed on to other people, including sexual partners. AGP can usuallydiagnose lichen planus by examining the rash and asking about your symptoms. Oral lichen planus is often diagnosed by a dentist during routine dental check-ups. Lichen planus is an itchy rash that can occur anywhere on the body. Source: https://dermnetnz.org/ Whos affected by lichen planus Lichen planus is thought to affect 1-2% of the worldwide population. Its more common in adults over the age of 40. Lichen planus of the skin affects men and women equally. However, oral lichen planus is more common in women. The mouth is affected in around 50% of all cases of lichen planus (oral lichen planus). Treating lichen planus Theres no single treatment that can cure lichen planus completely. However, treatments are availableto help manage the symptoms and make living with it easier. For example, steroid creams or ointments are often used to help relieve the itch and control the rash. Most cases of lichen planus of the skin clear up on their own within 6to 9months. The rash rarely lasts longer than 18 months.However, oral lichen planus and lichen planus that affects the genital area may be more persistent. Readmoreabout how lichen planus is treated . Erosive lichen planus Erosive lichen planus is a rare form of lichen planus that can last a long time. It causes painful ulcers to develop in the mouth and in the genital areas of bothmales and females. In some cases, long-term erosive lichen planus can increase the chance ofsome types of cancer developing. Read our page on complications of lichen planus for more information about erosive lichen planus. Symptoms of lichen planus The symptoms of lichen planus vary, depending on which area of the body is affected. Areas of the body most commonly affected by the condition include the: skin mouth penis vulva (external female sex organs) and vagina Lichen planus causes symptoms like itchy skin and red, slightly raised, bumps. Source: https://dermnetnz.org/ Lichen planus of the skin The symptoms of lichen planus of the skin are: purple-red coloured bumps (papules) that are slightly raised, shiny and have a flat top. The papules usually measure 3-5mm in diameter and may also have irregular white streaks (Wickhams striae) thicker scaly patches can appear, usually around the ankles  this is known as hypertrophic lichen planus itchy skin Lichen planus of the skin often affects the wrists, ankles and lower back, although other parts of the body can also be affected. Thickened (hypertrophic) lichen planus affects the shins, and ring-shaped lichen planus affects creases in the skin, such as the armpits. After thepapules have cleared, the affected area of skin can sometimes become discoloured. Lichen planus of the mouth (oral lichen planus) The symptoms of oral lichen planus are: a white pattern on the tongue and inner cheeks red and white patches in the mouth burning and discomfort in the mouth while eating or drinking painful red gums Mild cases of oral lichen planus dont usually cause any pain or discomfort. Lichen planus of the penis The symptoms of lichen planus of the penis are: purple or white ring-shaped patches on the tip of the penis (glans) bumps (papules) that are flat-topped and shiny a non-itchy rash Lichen planus of the vulva and vagina The symptoms of lichen planus of the vulva and vagina include: soreness, burning and rawness around the vulva the vulva may be covered in white streaks and be a red, pink or pale white colour if the vagina is affected, sexual intercourse can be painful if the outer layers of skin break down, moist, red patches can form scar tissue can form, which distorts the shape of the vagina a sticky yellow or green discharge,which may be bloodstained the opening of the vagina can become narrowed Other areas Lichen planus can sometimes affect other areas, including: the nails  which can become thinner, ridged and grooved, or they may become darker, thicker or raised; they may sometimes shed or stop growing the scalp  red patches can appear around clusters of hair; in some cases, permanenthair loss can occur Causes of lichen planus The cause of lichen planus is unknown. Its thoughtto be related to the immune system, or an abnormal response of the immune system to certain medicines. Lichen planus isnt infectious, doesnt usually run in families and cant be passed on to others. Autoimmune reaction The immune system protects your body against illness and infectionby producing antibodies (proteins)that attack bacteria and viruses. In people with lichen planus, its thought that the immune system becomes overactive, causing an excess amount of proteins to be produced, which inflame the skin. This is known as an autoimmune reaction and causes the symptoms of lichen planus . Reaction to medication A reaction to certain medications is another possible cause of lichen planus. For example: gold injections  these are disease-modifying anti-rheumatic drugs (DMARDs) that are sometimes injected into the muscles of people with arthritis to help reduce inflammation and painful joints antimalarial tablets  these help treat and prevent malaria (a serious tropical disease spread by mosquitoes) Diagnosing lichen planus Lichen planus is often diagnosed by a GP or dentist examining the affected area. Lichen planus of the skin Your GP may be able to make a diagnosis based on the characteristic rash.However, lichen planus can be mistaken for other skin conditions, such as eczema ,which also causes the skin to become red, flaky and itchy. If your doctoris unable to make a confident diagnosis by examining your skin, they may want to take a small skin sample ( biopsy ), which will be examined under a microscope. If a skin biopsy is required, youll be given a local anaesthetic to numb the affected area so you dont feel any pain or discomfort during the procedure. Lichen planus of the mouth (oral lichen planus) A dentist or doctor can diagnose oral lichen planus by looking at the inside of your mouth. A biopsy may be recommended to confirm the diagnosis. A sampleofmouth tissue will be removed so that it can be examined under a microscope.As with lichen planus of the skin, youll be given a local anaesthetic to numb the pain. Treating lichen planus Theres no cure for lichen planus, so treatments aim to ease the symptoms and clear the rash. Mild lichen planus doesnt require treatment. Self-help Below is some general self-help advice that can help ease your symptoms and prevent them getting worse. Lichen planus of the skin avoid washing with soap or bubble bath  use plain warm water instead wash your hair over a basin to stop affected areas of skin coming into contact with shampoo use anemollient to moisturise your skin Lichen planus of the mouth (oral lichen planus) avoid eating spicy foods and anything acidic, such as fruit juice, because they can irritate oral lichen planus avoid eating sharp food, such as crusty bread avoid drinking alcohol,particularly spirits if areas of your mouth are painful, stick to soft, bland foods, such as mashed potatoes and porridge if possible, continue to use your usual toothpaste avoid using mouthwashes that contain alcohol because they may be too strong, and keep your mouth as clean as possible visit your dentist regularly to help keep your teeth and gums healthy Lichen planus of the genitals avoid washing with soap or bubble bath  use plain warm water or a soap substitute instead, such as aqueous cream use an emollient, such as petroleum jelly, before and after urinating applying ice packs to the affected areas may soothe itchingand swelling (never apply an ice pack directly to your skin  wrapit in a clean tea towel before placingit on your body) women should avoid wearing tights Lichen planus of the skin, hair and nails There are a number ofmedicationsand treatments that may be recommended for lichen planus of the skin, hair and nails. These are outlined below. Corticosteroid creams and ointments Corticosteroid creams and ointmentscontain corticosteroids (artificial hormones) and are used to treat inflammatory skin conditions. They are oftenreferred toas topical corticosteroids . Topical corticosteroids help treat theswelling (inflammation) and redness caused by lichen planus. Strong topical corticosteroids, such as clobetasol propionate, are also effective in reducing any itchiness you may have. Treatment is applied to the red or purple itchy spots, but should be stopped when the colour of the rash changes to brown or grey. This pigment change occurs when the inflammation has settled. Continuing to apply the corticosteroid cream to the brown areas of skin willgradually cause the skin to thin. The side effects of corticosteroids can vary, depending on the: type and severity of treatment being used how long the treatment is used for nature of the condition being treated Potential side effects of topical corticosteroids can include: redness or burning and stinging of the skin skin rash thinning of the skin (atrophy) stretch marks (striae) contact dermatitis  a condition that causes skin inflammation excessive hair growth (hypertrichosis) lightening of the skin Always check the patient information leaflet that comes with your medicine. Corticosteroid tablets Corticosteroid tablets are sometimes used to treat severe cases of lichen planus, when the symptoms arent being effectively controlled with creams or ointments. Possible side effects of corticosteroid tablets used on a short-term basis can include: increased appetite weight gain insomnia fluid retention (inability to pass urine) mood changes, such as feeling irritable or anxious Other treatments Other treatmentsrecommended for lichen planus of the skin are outlined below. Antihistamines  these are often used to treat symptoms of allergies , such as itchy skin. If you have lichen planus of the skin thats causing itchiness, antihistamines may be prescribed to help reduce this. Light treatment  there are 2types of light treatment: ultraviolet B (UVB) and psoralen plus ultraviolet A (PUVA). UVB is the most commonly used light treatment, but PUVA may be recommended in severe or widespread cases of lichen planus that dont respond to other types of treatment. Acitretin  this medication is only prescribed by a specialist and is used to treat severe cases of lichen planus. The tablets have some associated side effects and may not mix well with other medicines. Your specialist can offer advice. Lichen planus of the mouth (oral lichen planus) Mild cases of oral lichen planus wont need any treatment. In more severe cases, treatment includes: a mouthwash that contains an anaesthetic to temporarily numb the mouth, which makes eating easier corticosteroid sprays, mouthwashes, pastes and dissolvable lozenges a mouthwash or gel that contains an antiseptic to help prevent the build-up of plaque in your mouth In more severe cases of oral lichen planus, corticosteroid tablets may also be used on a short-term basis. It can be difficult to prevent oral lichen planus, but to keep the lining of your mouth healthy its recommended that you: stopsmoking (if you smoke) avoid drinking large amounts of alcohol have a healthy, balanced diet , including plenty of fresh fruit and vegetables You should also maintain good oral hygiene by cleaning your teeth at leasttwice a day, and having regular dental check-ups ,so that any problems with your teeth or mouthcan be identified and treated early. Other treatments If corticosteroids are not effective in treating your symptoms, you may be prescribed a medication that suppresses your immune system to try to limit the autoimmune reaction thats thought to cause lichen planus. These types of treatments are known as immunomodulating agents. Depending on which area of your body is affected by lichen planus, treatments that may be recommended for you can include: treatments such as tacrolimus topical immunomodulating agents(used to treat lichen planus of the skin)  treatments such as tacrolimusointment andpimecrolimus cream are rubbed directly onto the skin immunomodulating agents(used to treat lichen planus of the mouth)  these are usually available in the form of tablets or capsules, and can be used to treat severe cases of oral lichen planus These treatments can causea number of different side effects, which your specialist can discuss with you. Youll also need to have regular blood tests while taking immunomodulating agents, particularly inthe early stages of treatment. Further information and support You can find support and information from organisations like: Changing Faces  a charity for people who have a visible difference or facial disfigurement, who can be contacted on 0300 012 0275 for counselling and advice Complications of lichen planus Complications of lichen planus may include discoloured skin and, in some cases, erosive lichen planus may develop into certain types of cancer. Skin pigmentation After the lichen planus rash has cleared up, the affected area of skin may be a different colour to what it was originally. There may be a brown or grey mark, which can sometimes last for months. This is known as post-inflammatory hyperpigmentation, and tends to be more noticeable in people with darker skin. Erosive lichen planus Erosive lichen planus is a long-lasting (chronic) form of lichen planus that causes painful ulcers to develop, as well as burning and discomfort in the genital areas of bothmale and females. Occasionally, in around 2% of cases, long-term cases of erosive lichen planus can develop into certain types of cancer , such as: mouth cancer vulval cancer penile cancer Regularly examining yourself and being aware of any changes that occur will help you to identify any problems at an early stage. Pay close attention to ulcerated areas in your mouth or genitals that dont heal and persist for a long time. Visit your GP immediately if you notice any changes that youre concerned about. You should also visit your dentist regularly to ensure that your teeth and gums remain healthy, and that any ulcers or patches that form in your mouth are examined and treated promptly. Depending on individual circumstances, dentalcheck-ups for adultsare recommended anywhere between every 3 to 24 months. Read more about treating lichen planus , including self-help tips for managing all types of the condition. 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