Lichen Planus

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What is lichen planus?

Lichen planus is a fairly common rash that usually develops on the skin or inside the mouth. The rash can be itchy or tender with some swelling and appear as either small, reddish purple raised bumps on the skin or as bluish-white spots in the mouth in a vaguely lacy pattern. The skin lesions tend to occur on the inside of the wrists or the torso, legs or genitals, but can also affect the scalp and nail beds. Mouth lesions most frequently affect the tongue or inside of the cheek but may occasionally appear on the gums.

Lichen planus most often affects middle-aged adults with a female predominance. It is not usually serious and may get better when treated with topical agents or medicated mouthwashes. Mild symptoms may not need treatment at all. In some cases, the disorder may last for weeks to months, usually clearing up within 18 months. Lichen planus can recur on and off for years after treatment, however. In rare cases, long-term ulcers in the mouth significantly increase your risk of developing oral cancer.

Lichen planus is rarely a serious disorder. However, left untreated, some cases do not resolve on their own but spread, and in the case of long-term ulcers inside the mouth, you run a higher risk of developing oral cancer. Seek prompt medical care if you have had mouth sores, an abnormal taste in the mouth, pain while chewing or swallowing, speech difficulties, or unexplained weight loss. Malignant lesions in the mouth may be painless at first and are often pale in color and may have deep cracks.

You should also seek prompt medical care if you are being treated for lichen planus but symptoms recur or are persistent, or if you have other concerns about your disorder.

What are the symptoms of lichen planus?

Symptoms of lichen planus include itchy or tender areas in the mouth or on the skin, possibly accompanied by swelling. Lesions on the skin may resemble pimples and usually appear as small, reddish-purple raised bumps. The rash appears as bluish-white spots on the tongue or inside the cheeks and can occasionally occur on the gums. The affected area may show a lacelike pattern. The skin lesions tend to occur on the inner wrists, legs, torso, or genitals. These symptoms may resolve on their own or with treatment, but they usually clear up within 18 months. If the condition is uncomfortable, medical treatment can ease these symptoms, which tend to be long lasting.

Common symptoms of lichen planus in the mouth

You may experience lichen planus symptoms for weeks to months at a time. Lichen planus symptoms tend to recur and can come and go for years. Symptoms in the mouth usually appear on the tongue, inside the cheek, or occasionally on the gums and include:

  • Bluish-white spots in a lacelike pattern

  • Mouth ulcerations

  • Spread of infection

  • Tender or painful lesions (mild cases may cause no discomfort)

Common symptoms of lichen planus on the skin

Symptoms on the skin usually appear on the inner wrist, legs, torso, or genitals, but can sometimes affect the scalp and nail beds and include:

  • Itchy skin

  • Nail changes such as longitudinal grooving, splitting, thinning, or loss

  • Papules (solid, raised spots) two cm to four cm across

  • Papules that are clustered together to form a larger, flat-topped lesion

  • Patches of hair loss

  • Shiny or scaly appearance

  • Single lesion or clusters of reddish-purple lesions with sharp, distinct borders

  • Skin ulcerations

  • Symmetrical appearance

Symptoms that might indicate a serious condition

In some cases, oral lichen planus can be a serious condition that should be immediately evaluated in an emergency setting. Seek prompt medical care if you, or someone you are with, have any of these serious symptoms including:

What causes lichen planus?

The exact cause of lichen planus is not known. It may be related to either allergy or immune reaction. Possible allergens include medications and other chemicals, including antibiotics, arsenic, chloroquine, diuretics, gold, iodides, phenothiazine or quinacrine.

What are the risk factors for lichen planus?

Though the cause of lichen planus is not known, there are risk factors that could increase your chances of developing lichen planus. Not all people with risk factors will get lichen planus. Risk factors for lichen planus include:

  • Exposure to possible allergens, especially medications, dyes, and chemicals such as antibiotics, arsenic, chloroquine, diuretics, gold, iodides, phenothiazine or quinacrine

  • Exposure to photo processing chemicals

  • Exposure to tattoo pigments

  • Hepatitis C and similar disorders

How is lichen planus treated?

Treatment of lichen planus focuses on reducing symptoms and speeding the healing of lesions. Although the disorder itself will take some weeks to months to resolve and can recur, mild symptoms may not need medication. If your physician does recommend treatment, you should follow your treatment plan carefully because lichen planus can spread to adjacent areas, and sores in the mouth can eventually form ulcers or blisters.

Medications for symptom treatment of lichen planus

The goal of treatment, for both skin and oral lichen planus, is to reduce your symptoms and speed the healing of skin lesions. Symptom-control medications include:

  • Immune-suppressing medications such as cyclosporine (Atopica, Gengraf, Neoral, Sandimmune) in severe cases only

  • Lidocaine-diphenhydramine-nystatin combination mouth washes for mouth lesions (First-BXN Mouthwash, First-Mouthwash BLM)

  • Oral corticosteroids such as prednisone (Deltasone, Liquid Pred)

  • Topical corticosteroids such as clobetasol (Clobex, Cormax, Temovate)

  • Topical retinoic acid cream (Tretinoin)

What you can do to improve your lichen planus

You can also prevent or limit lichen planus by:

  • Applying dressings over topical medications to protect your skin from scratching

  • Following instructions closely if “soak and smear” regimen is prescribed. Apply topical ointments to wet skin immediately after soaking in a lukewarm bath without drying. “Soak and smear” technique has demonstrated extraordinarily rapid healing.

  • Scheduling ultraviolet light therapy to alleviate skin symptoms, if prescribed

What are the potential complications of lichen planus?

Complications of untreated or poorly controlled mouth ulcers can be serious and can significantly increase your risk of developing oral cancer. Other potential complications include:

  • Alopecia
  • Cosmetic disfigurement
  • Nail destruction
  • Squamous carcinoma of the genitals
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 19
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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