Lichen planus is a common disease affecting the skin, nails, hair and mucosal membranes (mouth and genitalia). It can occasionally affect the anus, bladder and esophagus. It affects people between the ages of 30 and 70 and has an incidence of 0.5 to 2.2 percent of the population. Lichen planus can disappear without treatment, though one in five people will suffer a recurrence.
Symptoms
Twenty percent of patients with lichen planus on their skin will have no symptoms, while the majority suffer from itching. Lichen planus in the mouth can be symptomless or again itchy and painful with some patients developing mouth ulcers. Lichen planus in the nails results in ridging, while on the scalp it can lead to areas of baldness. Damage to the nails and scalp remain permanent on remission.
Appearance
Skin lichen planus appears as small red papules, whose numbers can vary. The rash can occur anywhere on the body but is most common on the inner wrists, lower legs and back. The bumps can develop white streaks. Oral lichen planus can be red or white plaques and is often bilateral.
Cause
The cause of lichen planus remains unknown, with many factors possibly contributing including autoimmune, genetics, stress and infection. It appears that some patients have a family history with an increased frequency of certain genetic types.
Diagnosis
Medical practitioners can often diagnose lichen planus by simply viewing the skin rash. However, sometimes a biopsy is needed, which will be viewed under the microscope. A medical practitioner will determine if the microscopic characteristics of lichen planus are present in the biopsy.
Treatment
Lichen planus can often resolve itself within 8 to 12 months. Patients that are sympto- free do not require treatment. Minor symptoms can be treated with topical steroids either as ointments or mouthwashes and pastes for oral lichen planus. Patients with severe lichen planus can be treated with systemic medication such as steroids or retinoids, but lichen planus can reoccur if treatment is stopped. Some patients with extensive lichen planus will respond to UVB and UVA light therapy, but risks with this treatment include skin cancer formation.
Prognosis
The majority of patients will see regression of their symptoms within 18 months. However, those with lichen planus, which affected their scalp, nails and genitalia, may find they have been left with permanent damage including scarring. A small percentage of patients with oral lichen planus, particularly those with ulcers, will develop oral cancer. Further, one in five patients will suffer a recurrence of their lichen planus.
References
- Informa World: HLA-DR3 antigens in erosive oral lichen planus, cutaneous lichen planus, and lichenoid reactions
- National Institutes of Health: Narrowband UVB therapy in the treatment of lichen planus
- National Institutes of Health: Risk of oral squamous cell carcinoma in 402 patients with oral lichen planus; a follow-up study in an Italian population; Gandolfo S et al; 2004; 40; 77-83
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