2022 Lichen Planus Handbook: Pictures, Symptoms and Treatment

"Lichen planus (LP) is the name given to an uncommon chronic skin rash that resembles a plant that typically grows on tree barks and rocks (lichen) and has a flat (planus) top surface. It is a poorly understood recurrent type of skin rash that can also affect the nails, inside of the mouth and/or the vagina. It is believed to be caused by an abnormal immune reaction. It cannot spread through contact, is not cancerous or precancerous. The condition has a higher incidence in adults aged 30 to 60. Oral or mouth lichen planus occurs more often in women. The condition often clears on its own in under 2 years. Approximately 20% of people will experience another outbreak. Some allergic reactions to medications or even toothpaste can manifest as lichen planus, particularly in the mouth.

See images of lichen planus on skin and in the mouth below.

The most prominent symptom is itch which can be addressed with prescription topicals such as a steroid or retinoid."

Lichen Planus Cause and Treatment

Dr. Amee Daxini discusses Lichen planus symptoms and risk factors.

What is Lichen Planus?

Lichen planus typically affects middle-aged adults. It is not as common in children. More women than men get the rashes in their mouths.

The Lichen Planus Skin Rash is characterized by flat topped pint to violet shiny papules Source: Meisenheimer Clinic

What exactly causes lichen planus is unknown (idiopathic). However, it has been associated in some places with people who have been infected with hepatitis C. It has also been linked to the intake of certain drugs like quinidine or quinacrine (antimalarial),diuretics (drugs for heart disease and high blood pressure), and other medications containing bismuth, arsenic, or gold. Similar skin eruptions have also been known to occur in some bone marrow transplant patients. Dental fillings made of metal may cause lichen planus to appear in the mouth, although this is rare. Others suspect that the condition may be an autoimmune disorder, but more studies have to be done.

A familial type of (bullous) lichen planusruns in families and the cause is not clear.

Lichen Planus pictures like this one show a lesion just starting to form. The condition is an autoimmune condition which your body's cells reacting to your own skin cells.

Diagnosis

Physicians can often make a straightforward diagnosis of typical cases by simply examining the rash. However, a skin biopsy may be needed to confirm the diagnosis.

There are a many skin eruptions that to resemble lichen planus (lichenoid) and a biopsy can confirm the suspicious lesions. Persistent lesions in the mouth and vagina may resemble leukoplakia, which are precancerous white plaques. In a few patients, ulcerative lichen planus may precede the development of oral cancer.

A Dermatologist might recommend blood tests to rule out other causes of any particular skin condition.

Chronic Case of Lichens Planus Symptoms on Back Source: AAD

Symptoms

Lichen planus appears on the skin as flat-topped rashes, which are violet or lilac in color and measuring a few millimeters. They are usually found in the inner wrist, forearm, lower leg, and lower back. The itchy lesions have symmetrical sides with sharp borders and they can occur as a single lesion or in clusters.Skin lesions may later develop ulcers or blisters.

The condition can suddenly appear (acute) or slowly erupt on the skin over several weeks.

Skin Rash Lesions - Lichen Planus on Wrist including Red/Purple Firm Skin Bumps Source: AAD

A variant form, known as hypertrophic lichen planus, appears thick, scaly, and reddish-brown in color. These are typically found on the shin and other body parts. These are especially persistent lesions that are very itchy. It is rare for the condition to appear on the scalp.

Lichen Planus Skin Rash Lesions on Leg

Lichen Planus Mouth

Oral Lichen Planus Skin Disease

Lesions in the mucous membranes (mouth and vagina) are also common. They appear as white, lacy rashes inside the cheeks or mouth. They may occur before the appearance of any skin rashes. Another variant that occurs as a troublesome sore is the erosive lichen planus, a rare type of lesion that causes shallow, painful, and recurrent mouth ulcers.

Oral Lichen Planus Symptoms:

Mouth pain
Red, open sores in the mouth
Small pale raised areas or bumps that form a lacy network on the gums, tongue or inside the cheeks
Red, white shiny slightly-raised patches on the tongue, cheeks or gums
Dry mouth
Sensation that the mouth is rough
Sore gums
Sensitivity to spicy or hot foods

The condition indicates a higher chance of getting oral cancer. Be sure to be screened for mouth and gum cancer 1x to 2x per year. Keep the mouth as clean as possible including 2x teeth brushing and nightly flossing. Visit a dentist every 6 months. Avoid caffeinated beverages, tomato based foods, spicy or acidic foods (fruits and fruit juice).

Any treatment options address symptom discomfort. Options include:

Corticosteroids for lesions
Medicated mouth sprays or rinses to numb or soothe any pain in the mouth
Immunosuppressant medications

Lichen Planus Mouth Symptoms are Small White Spots, Swelling, Gum Peeling and Sores Source: AAD

Lichen Planus on Genitals and Vagina

When lichen planus affects the genitals and the vagina, it may be confused with a sexually transmitted disease. However, lichen planus is neither contagious nor sexually transmitted.

Lichen Planus Skin Bumps are Firm to the Touch Source: AAD

Lichen Planus Nails (toenail or fingernail)

Lichen Planus can cause multiple symptoms on the nails including thinning, grooves or ridges, splitting and nail loss. The loss can be permanent or temporary.

Lichen Planus Symptoms on Nails Causes Nail Loss, Thinning, and Ridges Source: AAD

Treatment

Mild cases of lichen planus do not need treatment. Treatment is directed at reducing symptoms such as pain and itchiness and at promoting the healing of lesions. If drugs are suspected as the cause, they may be discontinued with a doctor’s advice. To limit symptoms try to reduce personal stress and avoid itching or scratching the skin.

Treatments may include:

oral antihistamines to reduce itching
topical corticosteroids to reduce inflammation and itching
cyclosporine can induce rapid remission
oral metronidazole which has been reported to be effective in some patients with idiopathic lichen planus who did not have concomitant protozoal infections of the genital or intestinal tracts⁽¹⁾

Hypertrophic LichenPlanus Treatment Using a Topical Ointment

Ultraviolet light therapy for persistent rashes (PUVA therapy) and when topical therapy does not work
In severe cases, low dose oral steroids such as prednisone may be prescribed

Dressings may be applied to prevent scratching of lesions.

Mouth sores may be relieved with lidocaine (a local anesthetic) mouthwashes used before meals.