Lichen Planus

Lichen Planus

Articlelichenplanus
Skin Care
Diseases & Conditions
+1
Contributed byLester Fahrner, MD+1 moreOct 12, 2023

What are the other Names for this Condition? (Also known as/Synonyms)

  • LP (Lichen Planus)

What is Lichen Planus? (Definition/Background Information)

  • Lichen Planus (LP) is a common, benign condition of generally unknown cause affecting the skin and mucus membranes. Individuals in the 30-60 years’ age group are generally affected the most
  • Classically, Lichen Planus skin lesions have been described as papular (elevated skin lesions), purple (purplish-red color), polygonal (not always round, some straight edges on lesions), and pruritus (often very itchy) - the “4 P’s”
  • These can occur anywhere on the skin of the body (and mucosal membranes) but are commonly found on the arms and legs. The main presentation of the lesions on the skin is itching; lesions in the mouth can cause pain
  • The treatment for Lichen Planus in symptomatic individuals may include the use of topical corticosteroid creams, immunosuppressive therapy, and phototherapy. The prognosis is generally good

There are many patterns or variants of Lichen Planus based on the site and type of lesion. Some of these include:

  • Actinic Lichen Planus: The skin lesions occur on the sun-exposed areas of hands, arms, and neck region
  • Atrophic Lichen Planus: The skin over the lesion is thinned out and it has a bluish-white appearance
  • Drug-Induced Lichen Planus: Sometimes, a variety of medications can cause this condition, which is treated by first discontinuing  the medication, and undertaking other (usual) treatments
  • Follicular Lichen Planus: It occurs on the scalp and results in hair loss (alopecia)
  • Hypertrophic Lichen Planus: The LP lesions are dark, with very thick adherent keratin buildup over the entire lesion. These thick skin lesions are particularly observed on the lower legs, arms,  and feet. A high occurrence rate of the condition among African Americans is seen
  • Lichen Planopilaris: The lesions of Lichen Planus surround hair follicles, most often on the scalp. Untreated or treated unsuccessfully, loss of the affected hairs can occur
  • Lichen Planus of Penis: It may affect the shaft of the penis or the glans penis. The lesions may be single or multiple and observed in a ring-like pattern
  • Lichen Planus of Vulva: It may affect the vulva or vaginal opening. The lesions may be single or multiple and observed in a ring-like pattern
  • Lichen Planus Pigmentosus: These lesions are pigmented dark in color and occur on the sun-exposed areas of the body. This condition is seen with a higher incidence in Latin America and darkly-pigmented populations
  • Oral Lichen Planus: The lesions occur in the mucosal membranes of the mouth, including the gums, cheeks, and tongue
  • Ulcerative Lichen Planus: The skin lesions (at any location) can ulcerate and become painful. These are difficult to treat (treatment-resistant) and may require immunosuppressive therapy or surgical excision with skin graft
  • Vesicular Lichen Planus: It is also known as Bullous Lichen Planus; the skin lesions are filled with fluid. A skin biopsy with immunofluorescence studies can help confirm its diagnosis
  • Lupus Erythematosus and Lichen Planus Overlap Syndrome: Clinical and pathological features of both Lichen Planus and lupus erythematosus are seen simultaneously in a patient

Who gets Lichen Planus? (Age and Sex Distribution)

  • Lichen Planus is a common skin condition that is typically seen in middle-aged to older adults in the age range of 30-60 years
  • It can affect both males and females, although females are affected more than males
  • The condition occurs worldwide; individuals of all racial and ethnic backgrounds may be affected

What are the Risk Factors for Lichen Planus? (Predisposing Factors)

  • The risk factors for Lichen Planus are presently unknown or unidentified

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Lichen Planus? (Etiology)

The exact cause of development of Lichen Planus, showing skin and mucus membrane involvement, is presently unknown (idiopathic) in a majority of cases.

  • In some cases, abnormal cell-mediated immunity may be the potential cause
  • There is no definitive proof that certain types of diet play a role in the development of this skin condition

Lichen Planus is non-contagious and is not transmitted from one individual to another; one cannot contract the condition through close physical interaction with the affected individuals.

What are the Signs and Symptoms of Lichen Planus?

Generally, the timing of development of the signs and symptoms is important in ensuring an accurate diagnosis. Lichen Planus has a slow onset; it may take days and weeks for the signs and symptoms to develop. Nevertheless, even though the skin lesions can be itchy, Lichen Planus may be asymptomatic in many individuals. After the onset of the condition, the lesions may last many months and, sometimes, even for years.

The signs and symptoms of Lichen Planus may include:

  • Itchy skin lesions that can occur individually or in groups anywhere on the body, including the mouth, scalp, and glans penis
  • Most frequently, the lesions are found in the arms and legs
  • There may be involvement of the nails, which may be malformed
  • The size of the lesion may vary from 1 mm to 10 mm
  • 50% of the individuals with Lichen Planus may have oral involvement
  • Lesions in the mucus membranes of the mouth appear as white patches and are painful; these may occasionally ulcerate
  • Chronic itching and scaling of the skin that causes the skin to become thick, discolored, and leathery

The severity of Lichen Planus may vary; it is difficult to predict who gets mild or severe symptoms.

How is Lichen Planus Diagnosed?

The following are the diagnostic methods and tests that may be used for Lichen Planus:

  • A thorough physical examination and a complete medical history are very crucial. A diagnosis of Lichen Planus may be arrived at clinically by analyzing the presentations
  • Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
  • Skin and/or mucosal biopsy: A skin biopsy is performed and sent to a laboratory for examination; a pathologist examines the biopsy under the microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. A skin biopsy is performed to rule out other similar conditions

Note: In most cases, based on the signs and symptoms, a diagnosis can be made by the dermatologist through a physical examination without a skin biopsy.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Lichen Planus?

The complications are dependent upon the type of Lichen Planus and the body part affected. These may include:

  • Bacterial and fungal infections: Lichen Planus may cause continuous itching and scaling of the skin, which creates skin moistness, providing a suitable environment for bacteria and fungi to grow and thrive
  • Rarely, squamous cell carcinoma (SCC) can develop from the lesions. Squamous cell carcinoma is infrequently seen developing on these skin lesions. Oral mucosal lesions are the most common site of malignant transformation to SCC
  • The lesions can last for years, resulting in self-image issues, emotional stress, and psychological trauma in some individuals
  • If the emotional stress is severe, it may even lead to depression and social isolation

How is Lichen Planus Treated?

In most individuals, Lichen Planus is a self-limiting disorder that requires no treatment. The condition subsides and goes away on its own. The symptoms are generally mild, and symptomatic treatment is also not required.

The treatment strategies that may be adopted in the management of Lichen Planus for those with significant signs and symptoms include:

  • For mild skin conditions, self-care measures are recommended, such as washing with mild (antibacterial) soap and applying a warm compress
  • Use of topical steroidal creams and lotions
  • Administration of systemic steroids
  • Oral corticosteroids are helpful in individuals with severe itching, painful oral lesions, pain while swallowing, and cosmetic issues
  • Immunosuppressive therapy, such as using cyclosporine, when Lichen Planus does not respond to steroidal treatments
  • Phototherapy or photochemotherapy can be used in generalized Lichen Planus and those that do not respond to the usual medications
  • For localized Lichen Planus or Lichen Planopilaris (affecting the scalp), phototherapy from a laser source or small lamp  directed only on lesional skin may be used
  • For severe cases of Lichen Planus, systemic retinoids may be tried
  • Surgical excision with skin grafts may be required in some cases
  • Providing reassurance and helping with feelings of stress and anxiety
  • Follow-up care with regular screening and checkups is important since the condition can last for many months and years

Note: If any of the prescribed treatment medications or methods cause new stinging or burning symptoms, it is important to discontinue the medication or method and immediately inform the healthcare provider.

A few self-care tips and home remedies for Lichen Planus may include:

  • Completely avoid scratching the affected areas
  • A comfortable, cool bath may help soothe the skin; avoid excessive washing and scrubbing of the skin
  • Wear smooth cotton clothes
  • Use only mild perfumes, soaps, and detergents
  • Drinking lots of water or fluids

How can Lichen Planus be Prevented?

  • Currently, there are no specific methods or guidelines available to prevent Lichen Planus
  • Careful and periodic monitoring or follow-up of the condition is recommended

What is the Prognosis of Lichen Planus? (Outcomes/Resolutions)

Lichen Planus may be asymptomatic in some individuals. Such individuals do not require any treatment; providing reassurance (if there are emotional issues) and maintaining periodic observance by the healthcare provider may be sufficient treatment.

  • There is no established cure for Lichen Planus. However, many individuals have mild symptoms, and the condition may spontaneously get better without any treatment. The lesions may completely disappear over time. The prognosis of Lichen Planus is excellent in such cases
  • In some individuals, the symptoms may appear, subside, and then recur with time. Besides, ulcerative lesions are difficult to treat. In such cases, symptomatic treatment may be provided to improve the quality of life
  • Individuals with milder signs and symptoms have a better prognosis than those with severe signs and symptoms
  • Regular follow-up visits with the healthcare providers are important

An old observation held that the course of Lichen Planus lasted about 18 months, which is quite variable.

Additional and Relevant Useful Information for Lichen Planus:

  • It has not been observed that dietary factors, such as oily foods and chocolate-based products, contribute to Lichen Planus development
  • Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken to avoid strong soaps and chemicals that could potentially worsen the condition
  • The presence of dirt on the body does not cause the condition. However, it helps to be clean and hygienic, which will help prevent the condition from getting worse

During the diagnosis of the various patterns of Lichen Planus, a differential diagnosis may be considered to eliminate other conditions. These conditions may include:

  • For Papular Lichen Planus: If there are multiple lesions, then cutaneous lupus erythematosus, contact dermatitis, and psoriasis; if there is a single lesion, then squamous cell carcinoma in situ and superficial type of basal cell carcinoma
  • For Vesicular Lichen Planus: Bullous pemphigoid and bullous lupus erythematosus
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On the Article

Krish Tangella MD, MBA picture
Approved by

Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team
Lester Fahrner, MD picture
Reviewed by

Lester Fahrner, MD

Chief Medical Officer, DoveMed Team

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