Lichen Planus

Lichen Planus (LP) is an itchy skin rash. In some people it also affects other surface parts of the body such as the mouth, nails or hair. It can be very itchy but usually goes after several months.

Who gets Lichen Planus?

About 1 in 100 people develop LP. It can occur at any age but most commonly develops in middle age. It is not an inherited disease. It is not an infection and the rash cannot be 'caught' or passed on to others.

What causes Lichen Planus?

  • The cause of LP is not known in most affected people. There is a type of inflammation in the skin which causes the rash. However, the cause of the inflammation is not known.
  • There are some known causes of LP which are very rare.
    • LP occurs as a rare side effect to some medicines. These include antimalarials, beta-blockers, anti-inflammatory medicines, thiazide diuretics and gold injections. The rash clears in a few weeks after stopping a medicine that caused it.
    • LP is sometimes caused by contact with certain chemicals used in colour photographic developing.

What are the symptoms of Lichen Planus?

1. LICHEN PLANUS OF THE SKIN

What does the rash look like?
The typical rash is small, red-purple bumps (papules). The bumps are usually shiny and flat-topped. They vary in size from a pinhead to about 1cm across. The number of bumps that develop varies. The rash can appear anywhere on the body but is most likely to occur on the inner wrists, lower legs and lower back. Fine white streaks often develop on the top of each bump.

Is it itchy?
Itch can range from mild to severe. A severe itch is common and is often the worst thing about LP. The itch may disturb sleep and affect the quality of life. The itchiness is unusual in that affected people tend to rub the rash rather than scratch to ease the itch.

How does the rash progress?
Sometimes the rash develops quickly over a few days. Sometimes each bump develops gradually over several weeks. Sometimes, several bumps form in a line along a previous scar. Sometimes several bumps clump together to form a large patch. New bumps may appear over time. Each bump tends to last several months before fading away. Usually, the whole rash takes between 3 -18 months to clear. A non-itchy brown or grey mark may be left on the skin where each bump had been. These may take several months or years to fade away.

2. LICHEN PLANUS OF THE MOUTH

  • About half of people with an LP skin rash develop white streaks on the inside of the cheeks, gums or tongue. This is usually painless and not itchy. It may not be noticed unless looked for. Sometimes this occurs without any skin rash.
  • LP can cause ulcers in the mouth but this is uncommon. If they occur they can be very sore and unpleasant. Hot or spicy foods are especially difficult to eat. Mouth ulcers can occur with or without the skin rash of LP.

3. LICHEN PLANUS OF OTHER PARTS OF THE BODY

Most people with LP just have the skin rash and/or the mouth involvement. Rarely, other areas are affected. These include the following.

  • Nails - about 1 in 10 people with LP have affected nails. It is usually just minor ridging of the nail. Severe damage to the nail can occur but is rare.
  • The scalp (which can cause patches of baldness) and other areas such as the inside of the vulva and the inside of the gullet (oesophagus) are rarely affected.

What is the outlook (prognosis) for people with Lichen Planus?

  • In general, the outlook is good. LP usually goes without leaving any ongoing problems.
  • Without treatment, about half of cases of LP clear within 9 months. The rest usually clear soon after this. It is unusual for it to last longer than 18 months. It persists longer in a small number of people who are severely affected. This is mostly in people who develop severe LP mouth ulcers.
  • About 1 in 5 affected people have a recurrence sometime in the future. A small number of people have several recurrences.
  • There is a slightly higher than average chance of developing other 'inflammatory' diseases. For example, colitis, liver inflammation, vitiligo etc. This is probably due to some people being more prone to 'immune' or 'inflammatory' conditions. However, most people with LP do not develop any of these other conditions.
  • If painful ulcers develop in the mouth due to LP, then there is higher than average chance of developing cancer of the mouth. Again, most people do not but regular mouth checks from a dentist are advisable.

What is the treatment for Lichen Planus?

There is no quick cure for LP. However, it is likely to clear in time. Treatment aims to relieve itching and improve the appearance of the rash until it goes away.

  • No treatment - is an option if symptoms are mild.
  • Antihistamine medicines - may help ease the itch. A antihistamine that makes you sleepy taken at bedtime may help sleep if the itch keeps you awake at night.
  • Steroid treatment - is commonly advised. Steroids reduce inflammation which eases the itch. Steroid cream applied to the rash is a common treatment. The effect of steroid cream is variable and it works in some people to ease itch better than others. Steroid mouth washes may help painful mouth ulcers if they occur. A course of steroid tablets may be advised if LP is severe. This may help 'tide over' a particularly bad spell. However, steroid tablets taken for longer than a few weeks are not usually advised due to possible side effects.
  • Acitretin tablets - have been shown to help ease symptoms in some people with LP. However, side effects may be a problem.
  • Immune suppressant medication - may be advised by a specialist if LP is severe. These include cyclosporin and azothiaprine. These reduce inflammation and are used in a variety of conditions where control of inflammation is difficult. Potential serious side effects mean that they are not used routinely but may be advised for people with severe LP.

In summary

  • Lichen planus (LP) causes an itch bumpy rash. Painless white streaks in the mouth are also common. Other problems and complications are uncommon.
  • LP usually lasts between 3 and 18 months.
  • Treatments such as steroid creams can ease symptoms (usually itch).
  • About 4 in 5 affected people only have one episode of LP. Some people have 2 or more episodes.

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