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

• ELP (Erosive Lichen Planus)
• Lichen Planus, Erosive type

What is Erosive Lichen Planus? (Definition/Background Information)

• Lichen planus is a common benign condition of generally unknown cause affecting the skin and mucus membranes. The skin lesions in lichen planus can occur anywhere in the body and are described using the four terms - papule, purple, polygonal, and pruritus
• Erosive Lichen Planus (ELP) is described as a subtype of lichen planus chronically affecting the mucus membranes, resulting in severe pain and ulcerative lesions. In a vast majority of cases, the involvement of the oral cavity surfaces and genitalia is noted
• Erosive Lichen Planus is believed to be an autoimmune disorder of T-lymphocytes (a type of white blood cells), with the skin manifestations being an inflammatory response of the body. The condition is commonly observed in adult women. Based on the mucosal sites of involvement, the two most common forms of ELP include:
  • Oral Erosive Lichen Planus: It typically involves the mucosal surfaces of the mouth
  • Genital Erosive Lichen Planus: It usually involves the penis in males and both the vulva and vagina in females
• The treatment for Erosive Lichen Planus is often difficult and challenging. The treatment measures may include the use of topical steroidal creams, immunosuppressive therapy, systemic medications, and surgery if needed. The prognosis is dependent on a variety of factors; although in many, the condition is longstanding and causes permanent scarring

Who gets Erosive Lichen Planus? (Age and Sex Distribution)

• Erosive Lichen Planus is a skin condition that is typically seen in middle-aged and older adults in the age group of 40-80 years (onset is common between ages 50 and 60 years). The condition is uncommon in children
• It can affect both males and females, although women are affected more than men in a 2:1 ratio
• The condition occurs worldwide; individuals of all racial and ethnic backgrounds may be affected

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

In many cases, the risk factors for Erosive Lichen Planus are not well-established.

• Use of certain medications causing drug reactions is reported in some cases
• An abnormal response of the skin microflora to some antifungal creams has possibly been implicated

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 Erosive Lichen Planus? (Etiology)

Erosive Lichen Planus, a subtype of lichen planus, is a severe autoimmune skin condition. It involves the T-cells (T lymphocytes) of the white blood cells and may be caused by damage to the skin cell layer, termed the basal epithelial cell layer. However, the exact cause of development of this autoimmune disease remains unknown.

• A few cases of Erosive Lichen Planus are drug-induced and gets better on ceasing usage of the offending medication. Some reports also inform that the condition may occur from viral infections or exposure to metals
• Some cases of lichen planus are known to develop through abnormal cell-mediated immunity; an association of the condition with other autoimmune diseases, such as alopecia areata, autoimmune thyroiditis, and vitiligo is noted

Erosive 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 Erosive Lichen Planus?

The signs and symptoms of Erosive Lichen Planus depend on the body site that is affected. This skin condition that affects the mucosal surfaces is typically severe and painful.

• Presence of raw and tender ulcers
• The lesions are chronic and painful
• They are known to bleed, ulcerate, and heal with scarring
• Within the mouth, the oral mucosa is affected - the gums, cheeks, or tongue may be involved
• When the genitals are involved, the glans penis in men and the vulvar and vaginal surfaces in females are affected

Other mucosal sites that may occasionally present Erosive Lichen Planus include the gastrointestinal tract (esophagus, rectum, and anus), urinary bladder, larynx, external ear canal, and the insides of the eyelids.

How is Erosive Lichen Planus Diagnosed?

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

• A thorough physical examination and a complete medical history are very crucial. A diagnosis may be arrived at clinically by analyzing the presentations
• Culture studies
• Tissue biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination, to examine the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed), and microscope findings, the pathologist arrives at a definitive diagnosis. A biopsy is performed to rule out malignancies and other similar conditions

A differential diagnosis is important to exclude skin disorders that present similar signs and symptoms. These may include:

• Autoimmune bullous diseases
• Behcet syndrome
• Crohn’s disease
• Erythema multiforme
• Stevens-Johnson syndrome
• Squamous cell carcinoma of skin

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 Erosive Lichen Planus?

The following complications of Erosive Lichen Planus may be noted:

• Cosmetic concerns
• Persistently painful lesions resulting in severe emotional and psychological stress
• If the emotional stress is severe, it may even lead to depression and social isolation
• Superimposed bacterial and fungal infections
• Eating and chewing difficulties
• Pain with sexual activity
• Permanent scarring upon healing
• Decreased quality of life
• Squamous cell carcinoma can develop from chronic and persistent lesions
• Treatment complications and side effects

How is Erosive Lichen Planus Treated?

The healthcare provider may adopt both topical agents and systemic medications in managing Erosive Lichen Planus since it is a persistent and challenging condition to treat.

The following treatment measures may be considered:

• Maintaining good oral and body hygiene
• Use of topical steroidal applications and/or calcineurin inhibitor creams and ointments
• Administration of systemic steroids such as prednisone
• Medications such as methotrexate, cyclosporin, or mycophenolate mofetil
• Oral antibiotics or antifungals for secondary infections, as required
• Surgical procedures, as necessary, particularly for genital Erosive Lichen Planus
• Providing reassurance and helping with feelings of stress and anxiety
• If Erosive Lichen Planus is medication-induced, stopping the causative medicine can help resolve the condition

Follow-up care with regular screening and checkups is important since the condition can last for many months and years.

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

• Completely avoid scratching the affected areas (keep fingernails trimmed)
• Avoid excessive washing and scrubbing of the skin
• Wear smooth cotton clothes and underwear
• Use only mild perfumes, soaps, and detergents
• Drinking lots of water or fluids

How can Erosive Lichen Planus be Prevented?

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

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

• The prognosis of Erosive Lichen Planus depends on a variety of factors such as:
  • Age and health status of the individual; immunocompromised individuals have a much worse prognosis
  • Severity of signs and symptoms and the development of complications
  • Response of the condition to treatment
  • Whether any transformation to malignancies is noted
• In many individuals, the condition is longstanding and persistent despite appropriate therapy; also, relapses are frequently noted
• The risk for cancer formation is between 1-3%, especially for cases that last for a long period (many years). The risk for squamous cell carcinoma formation is high in the following situations:
  • In chronic smokers
  • In individuals with a poor immune system due to various conditions
  • Infection by certain types of human papillomavirus (HPV); some HPV strains carry a high risk for cancer development

Additional and Relevant Useful Information for Erosive Lichen Planus:

• 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