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Lichen planus refers to a condition that can cause an itchy, bumpy rash on the skin or sometimes on the scalp or in the mouth. This is not an infectious rash, which is a good thing, but it can be difficult to put up with painful itching, and the condition can take several years to fully clear up. Others do have the inflammation clear sooner, within a few months.
There is not that much known about the causes of lichen planus. Some people who get it have scarring on their liver or have Hepatitis C, but many people who get it have normal and healthy livers, making this connection tenuous. Usually it most affects people who are in middle age, but people of other ages may get it too.
The symptoms of lichen planus include rash that can cover arms, legs, trunk, genitals, or scalp. The rash is flat on top, but it itches painfully, and can be any color from pink to red to purple. If the scalp is involved, hair loss is common. The rash is also noted for burning if it’s located on the mucus membranes, like parts of the genitals or in the mouth. When bumps are present in the mouth they usually become open sores, and some people note a metallic in their mouths or dry mouth.
Should people have a rash like this and suspect lichen planus it’s worth seeing a doctor. Though most treatments don’t immediately cure the illness, they may reduce inflammation and help people be more comfortable. Typical treatments for lichen planus can include creams with corticosteroids that help to reduce itching. Some people may need to take an oral steroid to help bring down inflammation more effectively. Medications like antihistamines might also be recommended to keep itching to a minimum.
As mentioned, it can take a while for lichen planus to resolve, and some people get the rash back again, just as it is seeming to go away. Oral forms of the condition are usually the most tenacious and make take the longest to cure. Eventually most people do recover from this painful skin condition and most won’t get it again.
It can be challenging while lichen planus is present because constant itching is certainly crazy-making. In addition to using whatever creams are recommended by a doctor, many people find they are made more comfortable by oatmeal or cornstarch soaks, and by wearing comfortable breathable clothing, made of natural fibers. Doctors could recommend other medications too if the condition is creating challenges with sleeping or concentrating. Sometimes using tranquilizers or merely using antihistamines can help.
Experts are not sure what the exact causes of lichen planus are. Many believe it is linked to an immune system disorder, where the person's white blood cells - which defend us from bad bacteria, viruses and other germs - mistakenly attack healthy tissues of the skin, mucous membranes, and hair.
Sometimes lichen planus may occur as a reaction to some medicines, such as:
Beta-blockers - medications that relieve stress on the heart, slow the heart beat, lessen the force of heart muscle contractions, and reduce blood vessel contraction in the heart, brain, and throughout the body.
Anti-inflammatory medications
Gold injections - for the treatment of arthritis
Antimalarials
Thiazide diuretics
Phenothiazines (a group of tranquilizing drugs with antipsychotic actions)
There is a link between contact with some chemicals used on color photographic development and lichen planus risk.
Mercury tooth fillings - some studies have found a link between lichen planus type changes in the mouth as a result of allergy to mercury tooth fillings. Signs and symptoms go away after the fillings are replaced with non-mercury ones.
Lichen planus can be part of Grinspan's syndrome - a syndrome characterized by hypertension, diabetes and oral lichen planus.
There is no cure for lichen planus, so treatments aim to ease the symptoms and clear the rash. Mild cases of lichen planus will not require treatment.
There are a number of medications that may be recommended to treat lichen planus of the skin, hair and nails.
Creams and ointments that contain corticosteroids (artificial hormones) are often used to treat inflammatory skin conditions. Topical corticosteroids are treatments that are applied directly to a specific area of the body.
Corticosteroid creams and ointments help treat swelling (inflammation) and redness that is caused by lichen planus. Strong topical corticosteroids, such as clobetasol propionate, are also effective in reducing any itchiness that you may have. Treatment is applied to the red or purple itchy spots, but should be stopped when the colour of the rash changes to brown or grey. This pigment change occurs when the inflammation has settled. Continuing to apply the corticosteroid cream to the brown areas of skin will increase the risk of the skin thinning. As strong corticosteroid creams are often used to treat lichen planus, before starting a course of corticosteroids you should refer to the patient information leaflet that comes with your medicine to ensure that you use the correct dosage and take note of any cautions and potential side effects.
Corticosteroid tablets are sometimes used to treat severe cases of lichen planus, when the symptoms are not being effectively controlled with creams or ointments.
Other treatments that may be recommended for lichen planus of the skin are described below.
Antihistamines: this type of medication is often used to treat symptoms of allergies, such as itchy skin. If you have lichen planus of the skin that is causing itchiness, antihistamines may be prescribed to help reduce this.
Lotions: moisturisers and emollients can also be effective in soothing the skin and relieving itchiness that is caused by lichen planus.
Light treatment: there are two types of light treatment - ultraviolet B (UVB) and psoralen plus ultraviolet A (PUVA). UVB is the most commonly used light treatment but PUVA may be recommended in severe or widespread cases of lichen planus that do not respond to other types of treatment. PUVA can cause side effects which your skin specialist (dermatologist) can discuss with you.
Acitretin: this medication is only prescribed by a specialist and is used to treat severe cases of lichen planus. The tablets have some associated side effects and may not mix well with other medicines. Your GP can advise you.
Mild cases of lichen planus of the mouth will not need any treatment. However, in more severe cases, treatment may be needed which may take the form of:
a mouthwash that contains an anaesthetic to temporarily numb the mouth and make eating easier
corticosteroid sprays, mouthwashes, pastes and dissolvable lozenges
a mouthwash or gel that contains an antiseptic to help prevent the build-up of plaque in your mouth
corticosteroid tablets may be used on a short-term basis in more severe cases of oral lichen planus
If corticosteroids are not effective in treating your symptoms, you may be prescribed a medication that works by suppressing your immune system to try to limit the autoimmune reaction that is thought to cause lichen planus.
These types of treatments are known as immunomodulating agents. Depending on which area of your body is affected by lichen planus, treatments that may be recommended for you could include:
topical immunomodulating agents: to treat lichen planus of the skin; treatments such as tacrolimus ointment and pimecrolimus cream can be rubbed directly onto the skin
immunomodulating agents: to treat lichen planus of the mouth; these are usually available in the form of tablets or capsules and can be used to treat severe cases of oral lichen planus