A Simple Guide to Lichen Planus

A Simple Guide to Lichen Planus
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What is Lichen Planus?
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Lichen Planus is a chronic inflammatory disease of the skin which typically consists of red small papules that joined together to from rough scaly patches.

It is often associated with lesions of the mucosal membranes.

What are the types of Lichen Planus?
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There are 2 main types:

1.Skin Lichen Planus is the most common type of Lichen Planus.
About 80% of people have red small papules that joined together to from rough scaly patches.

The skin usually grows very more quickly and are thicker than usual.

2.Mucosal Lichen Planus (small, red papular lesion of the mouth and mucous membranes)

Who Gets Lichen Planus?
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Lichen Planus occurs more in females than in males.

It is also more common in the middle ages.

It is rare in children

What causes Lichen Planus?
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The cause of Lichen Planus is unknown.

1.allergic reactions to medications for high blood pressure(methyl dopa) and arthritis (chloroquine and salicylates),arsenic, gold.

2.chronic hepatitis C virus infection

3.stress aggravate the condition

4.Allergic reactions to amalgam and gold filling can cause oral lesions


What are the symptoms of Lichen Planus?
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Onset is sudden or gradual.

They may last weeks or months and be recurrent.

Frequently they become chronic.

The typical rash of lichen planus is well-defined :
1.pruritic,
2.planar,
3.purple,
4.polygonal
5.papules.

When seen under the microscope the papules have characteristic network of white lines(Wickham's striae)

Lesions are symmetrical, usually on flexor surfaces of the arm near the wrist and the ankle.

Nails are frequently involved with pitting and thinning of the nail plate.

Oral lichen planus occurs in 50% of patients:

1. reticular form - most common rash, occurs as white streaks on the mucosa (known as Wickham's striae) or papules with small raised area .

The lesions are present on the gums, the tongue, palate and lips.

The lesions are present on both sides of the mouth

2. bullous form - fluid-filled vesicles

3. erosive form - erythematous (red) areas which are ulcerated.
This form may become malignant.

Microscopic appearance is typical of lichen planus:

1.Hyperparakeratosis or thickening of the granular cell layer
There is a typical saw-tooth appearance of the rete pegs

2.Degenerated basal cell layer

3.Inflammatory cells present in subepithelial layer of connective tissue

Lichen planus may involve the glan penis and vulvovaginal mucosa

Lichen planus rarely involve the eosophagus where it can cause erosive esophagitis and stricturing.

How does Lichen Planus affects the Patient?
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All types of Lichen Planus can affect a person’s quality of life.

Itching, soreness, and ulcers of the mouth are common.

What is the Treatment of Lichen Planus?
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Treatment depends on the severity and type of Lichen Planus.

1. mild cases may not require any treatment

2.severe Lichen Planus have lesions that affects most of the body and hospitalization is required.

3.Most cases of Lichen Planus lie in between.

Treatments:
1.Topical Medicines include:

topical steroids.
tar lotions, ointments, creams, and shampoo

2.Systemic therapy (oral drugs that affect the whole body system):

cyclosporins, methotrexate
immunosuppressant medications
Oral retinoids
Oral corticosteroids
hydroxychloroquine
tacrolimus
dapsone

3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A, radiation)

4.Combined therapy are frequently used.

5.new therapies such as the biologic agents has improved the condition

At the present moment there is no known cure for lichen planus.

Medicines have been able to reduce the severity of inflammation and improve the quality of life.

Other medicines are used to treat symptoms:

1.Antihistamines for itch

2.Oral topical steroids for mouth ulcers


What is the Prognosis of Lichen Planus?
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There is generally no cure for lichen planus.

Lichen planus may become dormant after being treated.

Recurrences are common even years after being dormant.

Lifelong treatment may be necessary to control signs and symptoms.