Lichen Planus

Lichen Planus
Body Parts: Whole Body
Medical Subjects: Skin

What Is Lichen Planus

What is lichen planus?

Lichen planus is a complex, itchy, inflammatory rash that leads to purplish red, polygonal, flattened papules on the skin (hence the name) often accompanied by pain.

Lichen planus can invade the skin of any part of the body, including the external genitalia, scalp, nails, and oral mucosa (pink, moist "skin" in the mouth).

Treatment of local lichen planus is mainly by injection of corticosteroids, and generalized lichen planus is mainly treated with oral medications or phototherapy. The average patient expects a good quality of life after treatment.

What are the types of lichen planus?

There are mainly skin lichen planus, genital lichen planus, oral lichen planus and hair lichen planus.

Is lichen planus common?

Limited data are available to investigate the incidence of lichen planus. It is estimated that less than 1% of the population have cutaneous lichen planus, 0.5% to 2% have genital lichen planus, 1% to 3% have oral lichen planus and hair lichen planus is less common.


What Is The Cause Of Lichen Planus

How do you get lichen planus?

The cause of lichen planus is currently unknown. There are many factors that may cause the disease, which may be related to neuropsychiatric factors, endocrine factors, systemic disease factors, genetic factors, viral infection or autoimmune.

Who have lichen planus?

Lichen planus is more common in adults and less common in children.

Is lichen planus contagious?


Can lichen planus be inherited?

Lichen planus may have a certain genetic predisposition because it is thought to be an autoimmune reaction.


What Are The Symptoms Of Lichen Planus

What are the common manifestations of lichen planus?

Lichen planus can cause different symptoms, depending on the body part involved.

  • Skin lichen planus: Lichen planus involves the skin when it will generally cause shiny, flat red or purple spots, these spots good hair in the wrist, arm or leg, but may also appear in other areas, often very itchy, in the process of recovery variable dark color. The typical manifestations of skin lichen planus can generally be described by four "Ps" in its clinical manifestations:

    • Pruritic

    • Purple,Is actually a purplish red

    • Polygonal, polygon

    • Papules

  • Lichen planus of nail of finger (toe): When nail of finger (toe) is involved, mild cases have only slight atrophy, and severe cases may have whole nail deletion. Disease process of nail lichen planus mainly occurs in nail bed.

  • Hair Lichen planus: Our patient developed regional alopecia with follicular keratinizing papules that, if not treated in time, can progress to cicatricial alopecia. Once the follicles are destroyed, the hair cannot regenerate.

  • Oral lichen planus: Mucosal lichen planus can occur alone or in combination with cutaneous lichen planus. Mucosal lichens planus may contain only lacy Wickham striae (papules or plaques with slender white lines on the surface) that are particularly prominent on the buccal mucosa, or may include papular, atrophic or erosive lesions. Erosive mucosal disease is often painful and may lead to secondary complications, including superficial candidiasis. Patients usually complain of persistent loss of appetite due to eating pain.

  • Genital lichen planus: Lichen planus of the male genitalia presents as a purplish-red papule on the glans penis, while lesions in women usually arise in the perineum. Vulvar-vaginal-gingival syndrome is an erosive lichen planus that affects the epithelial cells of the vulva, vestibule, vagina and mouth and is highly resistant to treatment. Although all three regions can be involved, the lesions may not occur simultaneously. The gingival epithelium is usually involved, but the buccal mucosa, tongue, and palate may present with erosions, white plaques, or a white lace-like network.

  • Esophageal lichen planus: Lichen planus may involve the esophagus with or without symptoms such as dysphagia or pain in swallowing. Possible endoscopic findings included pseudomembranous, fragile and inflamed mucosa, submucosal papules, lacy white plaques, erosion, stenosis, and other abnormalities. Patients often develop oral, genital, or skin lichen planus. The prevalence of esophageal lichen planus remains unknown.

  • Ear lichen planus: The stratified squamous epithelium of the external auditory canal and tympanic membrane is a potential site for lichen planus. The common clinical features of lichen planus of the ear include erythema, induration and stenosis of the external auditory canal; Tympanic membrane thickening; Ear leakage and hearing loss. Lichen planus may be present in other body parts, but it may not be. Further studies are necessary to determine the prevalence of this disease manifestation.


How To Check For Lichen Planus

How is lichen planus diagnosed?

Clinical evaluation of patients with suspected lichen planus includes questioning the patient and physical examination. The doctor asks the patient the following questions:

  • Drug history: Include drugs that may induce lichen planus.

  • Presence of skin itching: Is a common symptom of skin lichen planus.

  • Oral or genital erosion or pain: Suggesting the presence of combined mucosal lichen planus.

  • Dysphagia or pain in swallowing: Suggesting the discovery of esophageal disease.

The physical examination should include an examination of the entire skin surface, including the scalp, as well as an examination of the mouth and external genitalia. A thorough and detailed examination can help to assess the extent and extent of the skin lesions and to identify other affected sites.

  • When itchy, purplish red, polygonal papules or plaques appear on the skin;

  • A line or ridge formed on the nail;

  • Immediate medical attention should be paid to the presence of pink, moist "skin" inside the mouth, vagina and other organs that can cause painful red ulcers or whitish lacerated lesions.

    Understanding the symptoms and performing a physical examination can probably tell your health care provider if you have lichen planus, or you may take a small sample of your skin and send it to the laboratory for a biopsy to confirm the diagnosis.

What diseases are lichen planus easily confused with? How to distinguish?

  • Lichenoid drug eruption: The skin appearance of a lichenoid drug eruption is very similar to that of idiopathic lichen planus. The patient's medical history and skin biopsy can help to differentiate the lichenoid drug eruption from lichen planus.

  • Chronic graft-versus-host disease: The diagnosis can be facilitated by the patient's past history of hematopoietic cell transplantation.

  • Lichen sclerosus: Lichen sclerosus can cause structural distortion and labial adhesions, but unlike vulvar lichen planus, it rarely involves the vagina. Typical findings include whitish atrophic papules or plaques of the vulva, which may be hemorrhagic, purpuric, hyperkeratotic, bullous or aggressive.

  • Oral squamous cell carcinoma: Oral squamous cell carcinoma may present with erythematous or whitish patches, ulcerations or exophytic masses. A biopsy helps the diagnosis. 

The specific disease needs to be definitely diagnosed by a specialist, and medication cannot be taken by oneself to avoid delaying the disease.


How To Prevent Lichen Planus

Can lichen planus be prevented?

The etiology of lichen planus is currently unknown and cannot be prevented.


How To Treat Lichen Planus

Which department do you want to see for lichen planus?

The first diagnosis department of lichen planus is dermatology department. patients with oral mucosal damage and gingivitis can consult stomatology department.

Can lichen planus manage on its own?

The natural course of most skin lichen planus is remission within 1 to 2 years, and treatment focuses on accelerating remission and controlling pruritus.

Lichen planus of the mouth, genitals, scalp, nails often takes longer. In particular, oral and genital lichen planus (especially erosive) increases the risk of emotional anxiety and depression in patients and can have a significant negative impact on the quality of life of patients, which should be actively treated.

What are the treatment measures for lichen planus?

Treatment varies according to the body part involved and the severity of the symptoms and may generally include:

  • Glucocorticoid drugs: It is usually in the form of ointment, cream or gel, and can reduce inflammation and promote skin healing. These include fluocinolone acetate or 0.05% di-betamethasone dipropionate.

  • Calmodulin inhibitor: Such as tacrolimus.

  • Drugs that anesthetize the skin and relieve pain: Especially for patients with oral or sexual organ ulcers.

  • A drug that helps reduce inflammation or promote skin healing.

  • Light therapy: Ultraviolet light is generally used.

Some patients need to try more than one drug to find the most effective one.

What medicaments can lichen planus use to treat?

  • Skin lichen planus is mainly used cream glucocorticoid drugs such as fluocinolone acetate or 0.05% betamethasone dipropionate, and injection triamcinolone acetonide, etc.

  • Oral vitamin A acid can also significantly improve symptoms.

  • Oral antihistamines such as diphenhydramine may help control itchy skin.

  • Genital lichen planus, oral lichen planus, and hair lichen planus are mainly topically applied glucocorticoid drugs or calcineurin inhibitors such as tacrolimus. The correspond suppository can be selected for vaginal lichen planus.

  • For patients with pain, non-steroidal anti-inflammatory drugs such as ibuprofen or acetaminophen or local intraoral anesthetics such as 2% viscous lidocaine solution or 2% lidocaine gel can be added to control the pain.

Does lichen planus need hospitalization?

Not normally required. If the condition is serious, and the patient is infected or has anxiety or depression or a severely impaired quality of life, it is recommended to visit a hospital for professional help.

Will lichen planus recur?

Lichen planus usually disappears automatically after 1 to 2 years, but it still recurs in some people. Besides, vulvovaginal lichen planus and oral lichen planus have a long course of disease and become intractable or even difficult to cure.


What Should Patients With Lichen Planus Pay Attention To In Life

What should the patient of lichen planus notice in life?

  • Take good care of the skin, and wash and dry the skin gently when taking a bath. Do not scratch the itchy skin as much as possible, otherwise it will increase the chance of infection and aggravate lichen planus.

  • For lichen planus, be sure to take good care of the teeth and gums, brush your teeth twice a day with a soft-bristled toothbrush, and floss your teeth daily. Poor oral care can exacerbate lichen planus and may lead to other problems due to unhealthy teeth and gums.

  • In particular, patients with oral lichen planus should quit smoking or use smokeless tobacco, and reduce the intake of acid, salty, spicy, hot, sharp or rough food.

What should patients with lichen planus pay attention to in diet?

  • Patients with oral lichen planus should quit smoking and reduce the intake of acid, salty, spicy, hot, sharp or rough food.

  • Pay attention to less salt when cooking, less oil, less high salt seasoning, eat less pickled vegetables, pickled meat, etc.

  • Don't only eat refined rice and white flour as the main food; coarse grains, miscellaneous beans, potatoes, and pumpkins can be used to replace some of the main food.

  • Reasonable collocation of meat and vegetable, meat preferred chicken, duck, fish and other white meat, eat less fat, eggs, milk is an important source of protein and other nutrients.

  • If you are a vegetarian, you can eat more beans and soy products to supplement protein.

  • Eat more fresh fruits and vegetables.

  • Try not to drink.

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