Lichen planus (LP) is a chronic inflammatory condition that can affect the skin, hair, nails, and mucous membranes. It often manifests as an itchy rash of purple, flat-topped bumps that develop over several weeks. In the mouth, it can appear as lacy white patches, sometimes accompanied by painful sores. Affecting approximately 1-2% of the population lichen planus is not contagious. While the exact cause is unknown, it is considered an autoimmune disorder where the body’s immune system mistakenly attacks its own cells. This article offers a detailed exploration of lichen planus, encompassing its definition, classification, laboratory testing, treatment options, and the latest updates. Â If you have conditions like Lichen Planus, contact Derma Clinic Kathmandu Nepal for personalized diagnosis and treatment.
Definition of Lichen Planus
Lichen planus is an inflammatory condition that can affect various parts of the body, including the skin, mouth, genitals, scalp, and nails. It commonly appears on the skin as purplish, itchy, flat-topped bumps, often polygonal in shape. These bumps, known as papules, may have fine white lines or scales called Wickham’s striae. Lichen planus can also affect the female genitals, including the vagina.
Causes of Lichen Planus
The exact cause of lichen planus remains unknown. However, it is thought to be related to an overactive immune system that triggers inflammation in the skin and mucous membranes. Some potential triggers and associated factors include:
- Hepatitis C infection: Studies have shown a link between lichen planus and hepatitis C infection. A meta-analysis found a statistically significant association between HCV infection and lichen planus.
- Medications: Certain medications, such as those used for high blood pressure, arthritis, heart disease, and malaria, have been associated with lichen planus. This is known as lichenoid drug eruption.
- Allergic reactions: Some individuals may develop lichen planus as an allergic reaction to substances like the metal in dental fillings.
- COVID-19: Recent studies suggest a potential link between lichen planus and the COVID-19 virus and its vaccine.
Classification of Lichen Planus
Lichen planus can be classified based on the location and appearance of the lesions.
Types of Lichen Planus
| Type | Location | Description |
|---|---|---|
| Cutaneous lichen planus | Skin | This is the most common type and affects the skin, often appearing as itchy, purple, flat-topped bumps. |
| Mucosal lichen planus | Mucous membranes (mouth, genitals) | This type affects the mucous membranes, such as the inside of the mouth, where it can form lacy white patches or painful sores. It can also affect the genitals. |
| Lichen planopilaris | Scalp | This type affects the scalp and can cause hair loss, along with redness, irritation, and tiny bumps. |
| Lichen planus of the nails | Nails | This type affects the nails, causing changes in color, thinning, ridges, splitting, and potentially nail loss. It may also cause dark lines from the tip of the nail to the base. |
| Lichen planus of the esophagus | Esophagus | This type can cause difficulty swallowing and may lead to the formation of strictures (narrowing of the esophagus). |
Subtypes of Lichen Planus
In addition to the main types, there are also several subtypes of lichen planus, each with distinct characteristics:
- Hypertrophic lichen planus: This subtype is characterized by thick, scaly patches that are often itchy. It commonly occurs on the shins and ankles.
- Ulcerative lichen planus: This subtype presents with painful, erosive lesions that can make walking difficult. It is typically found on the soles of the feet or between the toes.
- Bullous lichen planus: This subtype manifests as blisters filled with fluid, often on the legs.
- Lichen planus pemphigoides: This subtype is a combination of lichen planus and pemphigoid, a blistering autoimmune disorder.
- Lichen planus pigmentosus: This subtype is characterized by pigmented lesions that are often arranged in a linear or Blaschkoid pattern.
- Inverse lichen planus: This subtype occurs in skin folds, such as the armpits and groin, where it may appear different from the typical lichen planus rash.
- Actinic lichen planus: This subtype is triggered by sunlight exposure and mainly occurs in young adults of Middle Eastern, East African, or Indian descent. It typically appears as red-brown annular plaques or hyperpigmented patches on sun-exposed areas.
Oral Lichen Planus
Oral lichen planus can be further categorized into six types:
- Reticular: This is the most common type and often appears as lacy white lines on the inside of the cheeks.
- Erosive: This type involves red, swollen tissues or open sores that can cause pain and discomfort.
- Papular: This type presents as small, raised bumps in the mouth.
- Plaque-like: This type appears as larger, raised patches.
- Atrophic: This type involves thinning of the mucous membranes.
- Bullous: This type is characterized by the formation of blisters in the mouth.
Differential Diagnosis
Lichen planus can sometimes resemble other skin disorders. Therefore, a healthcare professional may consider several conditions in the differential diagnosis, including:
- Psoriasis
- Chronic cutaneous lupus erythematosus
- Lichen simplex chronicus
- Secondary syphilis
- Pityriasis rosea
Laboratory Testing and Findings
Laboratory tests can help confirm the diagnosis of lichen planus and rule out other conditions.
Histopathology
A skin biopsy is a common diagnostic tool for lichen planus. A small sample of the affected skin is examined under a microscope to identify characteristic features, such as:
- Hyperkeratosis (thickening of the outer skin layer)
- Hydropic degeneration of basal epithelial cells
- A band-like infiltrate of lymphocytes at the dermo-epidermal junction
- Civatte bodies (degenerating keratinocytes)
Immunofluorescence
Direct immunofluorescence (DIF) may be used to diagnose lichen planus and differentiate it from other conditions. This test involves applying fluorescent antibodies to a skin biopsy sample to detect specific proteins. In lichen planus, DIF typically shows a shaggy pattern of fibrinogen deposition at the basement membrane zone. Indirect immunofluorescence can also be used to detect lichen planus specific antigen (LPSA) in the stratum spinosum and stratum granulosum, which can be particularly useful in diagnosing atypical cases of lichen planus.
Blood Tests
Blood tests may be conducted to rule out other conditions or identify underlying health problems that could be associated with lichen planus. For example, a blood test may be done to check for hepatitis C infection, Liver function test, Thyroid etc.,
Potential Side Effects and Complications
Lichen planus itself is usually not harmful, but it can cause discomfort and affect a person’s quality of life. Some potential complications include:
- Skin discoloration, which may persist even after the rash clears.
- Painful sores in the mouth or genitals, which can make eating, drinking, and sexual intercourse difficult.
- Scarring, especially in the genital area.
- Nail damage, including thinning, ridging, splitting, and potential nail loss.
- Hair loss, which may be temporary or permanent, particularly with lichen planus of the scalp.
- Increased risk of oral cancer in individuals with oral lichen planus.
Treatments for lichen planus can also have side effects. For example, topical corticosteroids can cause skin thinning , stretch marks , and contact dermatitis . Oral corticosteroids can lead to weight gain, mood changes, and an increased risk of infection. It is crucial to discuss the potential benefits and risks of any treatment with a healthcare professional.
Treatment Options and Latest Updates
The treatment for lichen planus depends on the location and severity of the lesions, as well as the individual’s overall health.
Topical Medications
Topical medications are often the first line of treatment for cutaneous lichen planus. These include:
- Corticosteroids: These help reduce inflammation and itching.
- Calcineurin inhibitors (tacrolimus and pimecrolimus): These can be helpful in reducing inflammation and discomfort.
- Retinoids (vitamin A derivatives): These may be used to promote healing and improve the appearance of the rash.
- Acetic acid soaks: These can be used to treat lichen planus in the genital area, helping to reduce bacteria, odor, and crusts.
Systemic Medications
For more severe cases, systemic medications may be necessary. These include:
- Oral corticosteroids: These can help reduce inflammation but may have side effects with long-term use.
- Antimalarial drugs (hydroxychloroquine): These can be effective in some cases of lichen planus.
- Immunosuppressants (cyclosporine, azathioprine, methotrexate): These medications suppress the immune system and may be used for severe or widespread lichen planus.
Light Therapy
Light therapy, or phototherapy, may be used to treat lichen planus affecting the skin. This involves exposing the affected skin to ultraviolet (UV) light, which can help reduce inflammation and promote healing.
Latest Updates
Recent research has focused on developing targeted therapies for lichen planus. One promising new treatment is baricitinib, an oral medication that blocks specific inflammatory pathways involved in lichen planus. Unlike many current treatments that have broader effects, baricitinib offers a potential disease-specific treatment option. In a clinical trial, baricitinib was shown to significantly improve symptoms in patients with treatment-refractory lichen planus.
Lifestyle and Home Remedies
Certain lifestyle measures and home remedies can help manage the symptoms of lichen planus:
- Good oral hygiene: For oral lichen planus, maintaining good oral hygiene, including brushing and flossing regularly, can help reduce discomfort and prevent secondary infections.
- Dietary modifications: Avoiding spicy, salty, or acidic foods can help minimize irritation in oral lichen planus.
- Stress management: Stress can worsen lichen planus symptoms, so finding ways to manage stress is important.
- Cool compresses: Applying cool compresses to the affected skin can help soothe itching and inflammation.
- Oatmeal baths: Soaking in a lukewarm bath with oatmeal-based bath products can help relieve itching.
Ongoing Research and Clinical Trials
Several clinical trials are underway to investigate new treatments for lichen planus. These trials are evaluating the safety and efficacy of various medications, including LP-10, a new liposomal-tacrolimus oral rinse.
Prognosis and Long-Term Outlook
The prognosis for lichen planus varies depending on the type and location. Cutaneous lichen planus often resolves within 18 months, although it may recur. Oral lichen planus tends to be chronic and may require ongoing management. Lichen planus of the scalp may sometimes lead to permanent hair loss.
Conclusion
Lichen planus is a chronic inflammatory condition that can affect various parts of the body. While there is no cure, various treatments are available to manage symptoms and improve quality of life. Recent research has led to promising new therapies, such as baricitinib, and ongoing clinical trials are exploring additional treatment options. Early diagnosis and appropriate management are essential for achieving long-term remission and maintaining a good quality of life. The information presented in this article provides a comprehensive overview of lichen planus, empowering readers with knowledge about this condition and its management.
For Comprehensive treatment for Lichen Planus visit Derma Clinic Kathmandu or Call us at 9801358600 for Appointment.