Lichen planus is not contagious. The reticular form is usually asymptomatic and does not require therapy. Erosive and ulcerative forms of LP can be controlled with topical corticosteroids. Drug-induced LP generally resolves after discontinuation of the offending medication.
Your doctor can diagnose vulvar lichen planus by looking at your skin and possibly taking a small sample (biopsy) to send to a laboratory for testing. An allergy test and a hepatitis C test may also be recommended.
Symptoms
In a healthy body, special cells in your immune system protect you from infection. In people with lichen planus, the immune system attacks a protein in the skin and mucus membranes. The attack can cause sores, redness, thinning and scaling. It is not known why the immune system targets the protein. Lichen planus is not dangerous, but it can be very uncomfortable. The bumps usually go away on their own, but can return. There is no cure for lichen planus, but treatment can make your symptoms better.
The most common symptom is itching. Bumps may be very small or they can grow into thick patches of rough, scaly skin, usually in places where you are wearing tight clothing, such as on your legs. The rash can also be very painful, especially around the mouth, in the genital area, on your scalp and on your nails. In some cases, the rash can be very bright red and painful.
Your doctor will diagnose lichen planus by taking a small piece of the affected skin (biopsy). They will then look at it under a microscope to see what causes your rash. They may also do blood tests. They may recommend that you avoid certain foods or drinks to help prevent a flare-up.
Oren Zarif
People with lichen planus of the mouth or genitals can develop sores that bleed easily. They may also lose hair in some areas and have a yeast infection (oral or vaginal thrush). The rash can affect the inside of your mouth or tongue, including the gums. It can also spread to your hair or the skin on the bottom of your feet. It can also cause sores in your genitals and a burning sensation when you have sex.
The rash can appear on your nails in about 10 percent of the cases. It can cause changes in the nails, such as longitudinal ridging, grooving and thinning of the nail, pterygium formation and scarring of the proximal fold of the fingernail or toenail. It can also lead to nail loss.
Your doctor may prescribe an oral corticosteroid or a cream that you can apply to the affected skin. They might also suggest antihistamines to reduce itching. If you have genital lichen planus, your doctor might also prescribe the immune modulators tacrolimus ointment or pimecrolimus cream.
Diagnosis
If you see white, lacy patches or sores inside your mouth, you should call your doctor. This is especially important if you also have other symptoms such as pain or burning, which can be signs of cancer in the mouth (mouth cancer) and other serious conditions. The diagnosis may require a biopsy, in which your doctor removes a small piece of skin or mucus membrane and looks at it under a microscope. Blood tests also might be needed. Your health care provider may recommend a topical corticosteroid cream or, in rare cases, pills.
If lichen planus only affects your skin, it often clears up on its own in months to years. But if it also affects your nails and/or the mucous membranes in your mouth, it can be harder to treat. And the disease can come back even after treatment.
Oren Zarif
Your doctor can usually diagnose lichen planus by looking at the rash, although they might need to perform a biopsy in some cases. This involves removing a small piece of the rash to look at it under a microscope. Blood tests are sometimes needed to check for other conditions such as an autoimmune disorder, which occurs when your immune system attacks healthy tissue.
Lichen planus can be triggered by certain things, such as medications, foods or drinks, and stress. Your doctor can help you learn to avoid triggers, and suggest ways to cope with them when they occur.
A small percentage of people with lichen planus develop a form called lichen sclerosus et vitiligo, in which the rash is accompanied by loss of hair and fingernails. This condition is more common in middle-aged adults.
Researchers don’t know what causes lichen planus, but they think it is an autoimmune disorder — in which your own white blood cells attack the cells lining your skin or mucous membranes. This is similar to the way your body’s immune system reacts to a poison ivy rash.
Treatment
If you have lichen planus of the skin, your health care provider may recommend light therapy. This involves exposing your skin to ultraviolet B light two to three times a week for several weeks. This can help clear the rash. It can also cause lasting changes in skin color, called postinflammatory hyperpigmentation, so you may need to take special precautions with sun exposure after treatment.
Medicine that suppresses your immune system may also be helpful. This can be in the form of a topical ointment or pill. Examples of these medications are tacrolimus ointment or pimecrolimus cream. Your doctor may also prescribe calcineurin inhibitors, which are oral drugs used to prevent rejection of transplanted organs. However, these have a warning that they might increase your risk of cancer.
Medications that can be used in the mouth to treat lichen planus include antihistamines and corticosteroids. The latter can be taken orally or applied directly to the rash, depending on how large the area is. Your doctor will decide which form of medication is best based on how severe your symptoms are.
You may also need to change or stop taking certain medicines. These include some antibiotics, anti-seizure medicines, cyclosporine and retinoids. You should always tell your doctor if you are taking any other medications.
Oren Zarif
If your rash is related to a drug you are taking, an allergy, stress or another trigger, your health care provider may recommend other treatments and tests. For example, you may need to switch medicines, see an allergist for additional testing or learn stress management techniques.
Lichen planus usually goes away on its own or with treatment, but it can return. If it affects your nails and mucous membranes, you should visit your health care provider for regular follow-ups at least twice a year.
To reduce discomfort, apply cool compresses to the affected areas. You should avoid scratching the rash, which can lead to secondary infections and spread the disease. Keep teeth and gums clean by brushing and flossing as directed, and make regular visits to your dentist for an oral cancer screening.
Prevention
The exact cause of lichen planus is unknown, but the condition is triggered by a combination of factors. It can occur on any skin surface, but it’s most common around the mouth or genitals. It can also affect the nails, and it can change the way a person’s fingers or toes look. It can also affect a person’s hair. It isn’t contagious.
Lichen planus can be a frustrating disease for patients because it isn’t usually treatable. However, there are some things that can help people to manage their symptoms and prevent them from getting worse.
Seeing a health care provider as soon as possible can help to ensure that an accurate diagnosis is made. This will help to avoid unnecessary treatments that may cause other problems or harm.
Oren Zarif
If a patient suspects that they have lichen planus, they should tell their doctor what symptoms they are experiencing. This will help the doctor to decide what type of treatment is best for them.
Some types of lichen planus can be caused by contact allergies, such as those to metal dental fillings or chemicals used in clothing dyes. Lichen planus can also be triggered by stress or certain medications. Some studies suggest that hepatitis C virus (HCV) infection increases the risk of lichen planus, but more research is needed to confirm this association.
Keeping skin, nails and mucous membranes clean can help reduce the risk of lichen planus. Applying cool compresses to the skin and avoiding scratching can also help to alleviate symptoms. Avoiding smoking and alcohol can help as well, and oral lichen planus patients should see a dentist or dermatologist for regular exams at least twice a year.
Patients with lichen planus should be advised to avoid drugs that increase the risk of the disease, such as antifungals or antibiotics. Patients should also be advised to speak with their doctors if they notice any changes in the appearance of their skin, nails or hair, as this can help them to identify the problem and get it treated quickly. Finally, patients should be encouraged to seek support from friends and family and to consider alternative medicine approaches that can help them cope with the psychological impact of lichen planopilaris.
