Understanding Lichen Planus: Symptoms, Signs, and Treatment Options

What is Lichen Planus?

Lichen planus is a chronic inflammatory condition that can affect your skin, mucous membranes, and in some cases, your nails and scalp. This condition is not contagious but can be uncomfortable and sometimes painful. In India, lichen planus is relatively common, affecting people of all ages, though it’s more prevalent in middle-aged adults.

The name “lichen planus” comes from the appearance of the skin lesions: “lichen” refers to the flat, tree-moss-like appearance, while “planus” means flat in Latin. Despite its name, lichen planus has nothing to do with the lichen you might find growing on trees or rocks!

Common Symptoms of Lichen Planus

Lichen planus can manifest in various ways, depending on which part of the body it affects. Here are some of the most common symptoms:

Skin Symptoms

Small, flat-topped, purple or reddish-purple bumps (papules)
Itching, which can range from mild to severe
Lesions that may develop white lines known as Wickham’s striae
Skin discoloration after the lesions heal (post-inflammatory pigmentation)

Oral Symptoms

White, lacy patches inside the cheeks, on the tongue, or on the gums
Red, swollen, and painful gums
Burning sensation in the mouth
Sensitivity to hot or spicy foods

Genital Symptoms

Itching and discomfort in the genital area
Erosive lesions that can be painful
In women, vaginal discharge or pain during intercourse

Nail Symptoms

Thinning or splitting of the nails
Longitudinal ridging or grooving of the nails
In severe cases, permanent nail loss

Scalp Symptoms

Redness, scaling, and itching of the scalp
Hair loss, which may be temporary or permanent

It’s important to note that not everyone with lichen planus will experience all these symptoms. The severity and duration of symptoms can vary greatly from person to person.

Signs to Look Out For

While symptoms are what you feel, signs are what can be observed. Here are some signs of lichen planus that you or your doctor might notice:

Visible Skin Changes

The most characteristic sign of lichen planus is the appearance of small, flat-topped, shiny, and reddish-purple bumps on the skin. These bumps often have a distinctive polygonal shape and may be covered with fine, white lines or scales known as Wickham’s striae.

Distribution Pattern

Lichen planus often follows a specific distribution pattern on the body. Common areas include:

Inner wrists and ankles
Lower back
Neck
Legs
Genitals
Inside of the cheeks and on the tongue

Koebner Phenomenon

This is a unique feature of lichen planus where new lesions appear at sites of skin injury or trauma. For example, a scratch or a cut might lead to the development of new lichen planus lesions along the injured area.

Nail Changes

In some cases, lichen planus can affect the nails, leading to visible changes such as:

Longitudinal ridging or grooving
Thinning of the nail plate
Pterygium formation (when the skin extends from the nail fold onto the nail plate)
In severe cases, the entire nail may be destroyed

Oral Lesions

If lichen planus affects the mouth, you might notice:

White, lacy patterns on the inside of the cheeks, gums, or tongue
Red, swollen patches in the mouth
Ulcers or erosions in severe cases

Diagnosis of Lichen Planus

If you suspect you have lichen planus, it’s crucial to consult a dermatologist or a healthcare provider. They will typically diagnose the condition through:

Physical examination: The doctor will closely examine your skin, mouth, and nails for characteristic signs of lichen planus.
Medical history: They’ll ask about your symptoms, when they started, and any potential triggers or associated conditions.
Skin biopsy: In some cases, especially if the diagnosis is uncertain, your doctor may perform a skin biopsy. This involves taking a small sample of affected skin for microscopic examination.
Blood tests: These may be done to rule out other conditions or to check for associated autoimmune disorders.

Treatment Options for Lichen Planus

While there’s no cure for lichen planus, various treatments can help manage symptoms and promote healing. The choice of treatment depends on the severity of your symptoms and the areas affected.

Topical Treatments

Corticosteroid creams or ointments: These are often the first line of treatment for skin lesions. They help reduce inflammation and itching.
Calcineurin inhibitors: Medications like tacrolimus or pimecrolimus can be used, especially for sensitive areas like the face or genitals.
Retinoids: Topical retinoids may be prescribed for some cases of lichen planus.

Oral Medications

Oral corticosteroids: For severe or widespread lichen planus, oral steroids might be prescribed for a short period.
Antihistamines: These can help relieve itching.
Systemic retinoids: In some cases, oral retinoids like acitretin may be used.
Immunosuppressants: For severe or resistant cases, drugs like cyclosporine or methotrexate might be considered.

Light Therapy

Phototherapy: This involves exposing the skin to controlled amounts of ultraviolet light. It can be effective for widespread lichen planus.

Treatments for Oral Lichen Planus

Topical corticosteroids: These can be applied directly to oral lesions.
Oral rinses: Special mouthwashes containing corticosteroids or other medications may be prescribed.
Systemic medications: In severe cases, oral medications might be necessary.

Home Remedies and Lifestyle Changes

While medical treatments are often necessary, some home remedies and lifestyle changes can help manage lichen planus:

Cool compresses: Applying cool, wet compresses to affected areas can help soothe itching and burning.
Oatmeal baths: These can provide relief from itching.
Avoiding irritants: Identify and avoid any triggers that seem to worsen your symptoms.
Gentle skincare: Use mild, fragrance-free soaps and moisturizers.
Stress management: Since stress can exacerbate lichen planus, practices like yoga, meditation, or deep breathing exercises may be helpful.
Diet modifications: Some people find relief by avoiding spicy or acidic foods, especially for oral lichen planus.

Living with Lichen Planus

Living with lichen planus can be challenging, but with proper management, most people can control their symptoms effectively. Here are some tips for coping with the condition:

Follow your treatment plan: Stick to the treatment regimen prescribed by your doctor, even if symptoms improve.
Regular check-ups: Keep regular appointments with your healthcare provider to monitor the condition and adjust treatment as needed.
Join support groups: Connecting with others who have lichen planus can provide emotional support and practical tips.
Protect your skin: Avoid scratching affected areas and protect your skin from injury to prevent new lesions from forming.
Stay informed: Keep yourself updated about the latest research and treatment options for lichen planus.

When to See a Doctor

While lichen planus often resolves on its own over time, it’s important to seek medical attention if:

You notice new, unexplained rashes or lesions
Your symptoms are severe or worsening
You experience persistent mouth sores
You have genital lesions
Your symptoms are affecting your quality of life

Remember, early diagnosis and treatment can help manage symptoms more effectively and prevent complications.

Conclusion

Lichen planus, while often challenging to live with, is a manageable condition. With proper diagnosis, treatment, and self-care, most people with lichen planus can effectively control their symptoms and maintain a good quality of life. If you suspect you might have lichen planus, don’t hesitate to consult a healthcare provider. They can provide a proper diagnosis and work with you to develop an effective treatment plan tailored to your specific needs.

Remember, everyone’s experience with lichen planus is unique. What works for one person may not work for another, so it’s important to work closely with your healthcare provider to find the best approach for you. With patience and persistence, you can successfully manage lichen planus and minimize its impact on your daily life.

Dr Sagar Kajbaje