Lichen planus

Lichen Planus is a chronic inflammatory condition that affects the skin, mucous membranes, hair, and nails. It presents as purplish, flat-topped bumps that may be itchy or painful. The exact cause is unknown, but it's believed to involve an autoimmune reaction where the body's immune system mistakenly attacks its own tissues. Lichen Planus can occur on various parts of the body, including the wrists, ankles, mouth, genitals, and scalp. Treatment focuses on managing symptoms and may include topical or oral medications to reduce inflammation and itching.

If you suspect you or someone else is experiencing Lichen Planus, it is crucial to seek immediate medical attention by calling emergency services or consult with a Dermatologist.

Causes

• Autoimmune Reaction: Lichen planus is thought to occur when the body's immune system mistakenly attacks healthy cells, including skin cells and mucous membranes.
• Genetic Predisposition: There may be a genetic component to lichen planus, as it sometimes runs in families.
• Triggering Factors: Certain factors can trigger or exacerbate lichen planus, such as viral infections (like hepatitis C), allergens, stress, and certain medications (like non-steroidal anti-inflammatory drugs and beta-blockers).
• Viral Infections: Some cases of lichen planus may be associated with viral infections, particularly hepatitis C virus.
• Chemical Exposures: Exposure to certain chemicals or dyes has been linked to lichen planus in some individuals.
• Unknown Factors: In many cases, the specific trigger for lichen planus remains unknown (idiopathic).
• Oral Lichen Planus: Factors like poor oral hygiene, dental materials, and chronic irritation in the mouth may contribute to oral lichen planus.

Risk Factors

• Genetic Predisposition: Family history of lichen planus increases the risk of developing the condition.
• Autoimmune Disorders: Individuals with autoimmune diseases like rheumatoid arthritis or lupus are more susceptible.
• Viral Infections: Certain viral infections, including hepatitis C virus (HCV) and hepatitis B virus (HBV), may trigger lichen planus.
• Medications: Certain medications such as beta-blockers, nonsteroidal anti-inflammatory drugs (NSAIDs), and medications for heart disease can induce lichen planus.
• Allergies: Allergic reactions to medications, dental materials, or other substances may contribute to the development of lichen planus.
• Stress: Psychological stress and emotional trauma have been associated with lichen planus flare-ups.
• Hormonal Factors: Hormonal changes, such as those occurring during menopause, may influence the onset or exacerbation of lichen planus.
• Environmental Triggers: Exposure to certain chemicals, dyes, or metals can potentially trigger lichen planus lesions.
• Age and Gender: Lichen planus can occur at any age but is more common in adults and slightly more prevalent in women than in men.
• Oral Hygiene: Poor oral hygiene and dental factors have been linked to the development of oral lichen planus.

Symptoms

• Skin Lesions: Characterized by flat-topped, shiny, reddish-purple bumps that may appear on the wrists, ankles, lower back, or genitals. These lesions may be itchy or painful.
• Mucous Membrane Involvement: Lesions can also occur inside the mouth, on the tongue, gums, or inner cheeks, presenting as white, lacy patches or open sores.
• Nail Changes: Thickening, grooving, or ridges on the nails, along with nail loss in severe cases.
• Hair Loss: Temporary or permanent hair loss in affected areas, such as the scalp.
• Itching: Often accompanies skin lesions, contributing to discomfort and irritation.
• Pain or Burning Sensation: Particularly in lesions involving mucous membranes, eating or drinking acidic foods may exacerbate discomfort.
• Koebner Phenomenon: New lesions may appear at sites of skin trauma, such as cuts, abrasions, or surgical scars.
• Genital Involvement: Lesions may occur on the genitals, causing discomfort during sexual activity.
• Symptoms in Other Areas: Rarely, lichen planus may affect the esophagus, causing difficulty swallowing.
• Chronic Course: The condition can persist for months to years, with periods of flare-ups and remissions.

Diagnosis

Medical History: Understanding the patient's medical history, including any previous skin conditions or autoimmune diseases.
Physical Examination: A thorough examination of the skin, nails, and mucous membranes to identify characteristic signs such as papules, plaques, and lesions.
Biopsy: Often considered the gold standard for diagnosis, a biopsy involves removing a small sample of affected skin tissue for microscopic examination. This helps in confirming the presence of lichenoid inflammation and ruling out other conditions.
Dermatoscopy: Used to closely examine skin lesions under magnification, aiding in distinguishing lichen planus from other similar dermatological conditions.
Patch Testing: In cases suspected to be triggered by allergens or contact with certain substances, patch testing may be performed to identify potential triggers.
Blood Tests: Occasionally, blood tests may be ordered to rule out other systemic conditions or to assess liver function in cases of oral lichen planus.
Oral Examination: For oral lichen planus, a dentist or oral specialist may conduct a thorough examination of the mouth and mucous membranes.
Histopathological Examination: Microscopic analysis of tissue samples obtained from affected areas to examine the characteristic features of lichen planus.

Treatments

Topical Treatments:

• Corticosteroid creams or ointments are commonly prescribed to reduce inflammation and itching.
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) may be used as an alternative for sensitive areas.

Oral Medications:

• Systemic corticosteroids are prescribed for widespread or resistant cases, but long-term use is avoided due to potential side effects.
• Retinoids (acitretin) or immunosuppressants (methotrexate, cyclosporine) may be considered for severe cases.

Phototherapy:

• UV light therapy (narrow-band UVB) can help reduce inflammation and improve skin lesions.

Antihistamines:

• These may be recommended to relieve itching associated with lichen planus.

Oral Care:

• Mouthwash or oral corticosteroids for oral lichen planus to reduce discomfort and inflammation in the mouth.

Lifestyle and Home Remedies:

• Gentle skin care practices and avoiding known triggers can help manage symptoms.
• Avoiding spicy or acidic foods and maintaining good oral hygiene are important for oral lichen planus.

Follow-Up Care:

• Regular monitoring is necessary to assess response to treatment and manage any side effects.

Preventive Measures

• Avoid Triggers: Identify and avoid triggers known to exacerbate lichen planus, such as certain medications, allergens, and stress.
• Oral Hygiene: Maintain good oral hygiene practices to reduce the risk of oral lichen planus. Regular brushing, flossing, and dental check-ups are essential.
• Avoid Trauma: Be cautious to avoid trauma to the skin or mucous membranes, as injuries can trigger or worsen lichen planus lesions.
• Manage Stress: Practice stress-reducing techniques like yoga, meditation, or therapy, as stress can exacerbate symptoms.
• Monitor Medications: Be aware of medications that may trigger lichen planus and discuss alternatives with healthcare providers if necessary.
• Quit Smoking: Smoking cessation can improve overall health and reduce the risk of oral lichen planus.
• Protect Skin: Use gentle skincare products and protect skin from excessive sun exposure, which can aggravate lichen planus lesions.

Do's & Don’t's

If you suspect you or someone else is experiencing Lichen Planus, it is crucial to seek immediate medical attention by calling emergency services or consult with a Dermatologist.