What is Lichen Planus?

Lichen planus is a common, chronic mucocutaneous disease that affects a wide area of the skin, tongue, genitalia, and oral mucosa.

The cause is still undefined. Some of the lichenoid reactions occur as hypersensitive reaction to certain medications, in such cases termed drug-induced lichenoid reactions. It is also thought to be caused by an anomalous immune reaction aggravated by Hepatitis C viral infection.

On top of the cutaneous eruption, lichen planus involves other parts like the mucous membrane, genitals, nails and the scalp. The classical manifestation is in a form of flat-topped papules or rashes which are shiny and violaceous. There is variation in size from 1 mm to greater than 1 cm in diameter. Wickham striae are regularly found on the papules which appear as fine, white lines.

The mouth is affected in 50% of the cases. Because of mucous membrane involvement, lesions are common on the tongue and in the buccal mucosa. These oral lesions are distinguished by painless gray or white streaks which outline a fern-like pattern on the violaceous skin. There are as well quite painful and persistent ulcers and scattered redness and shedding of the gums.

10% of lichen planus cases involve one or more nails. Affected nail plates are likely to be thin and could become grooved and uneven. There may be onycholysis wherein the nails grow dark, thicken and separate from the nail bed. The nails may drop, cease growing and may vanish completely.

The disease is self-limited and typically resolves in 8 to 12 months so the treatment is not always essential. If pruritus is worse, the physician may suggest an antihistamine. In mild cases of lichen planus, fluorinated topical steroids are used. A thin film should be rubbed accurately once a day and is terminated when the lesions have flattened. If the mouth is involved, steroid paste may be easier to apply. If the genitals are affected, hydrocortisone foam is prescribed. More intensive therapy involving systemic steroids like prednisone is needed to treat severe cases particularly those with mucous membrane involvement.

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