Lichen Planus

Overview

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Lichen planus is an inflammatory skin condition that can also affect mucous membranes, hair, and nails. It appears as flat, purplish, itchy lesions and can be acute or chronic. The exact cause is unknown, but it is believed to involve an autoimmune response where the body’s immune system attacks its own skin cells.

It appears as flat, purplish, itchy lesions and can be acute or chronic. The exact cause is unknown, but it is believed to involve an autoimmune response where the body’s immune system attacks its own skin cells.

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Symptoms
  • Skin Lesions: Flat, shiny, and often itchy purple or violet lesions, typically found on the wrists, ankles, lower back, and genitals.
  • Mucosal Lesions: White, lacy patches or sores in the mouth or genital area.
  • Nail Changes: Thinning, ridges, or nail loss in severe cases.
  • Hair Loss: Potentially causing scarring alopecia if the scalp is involved.
Complications
  • Scarring: Chronic lesions can lead to skin atrophy or scarring.
  • Secondary Infections: Scratching lesions can lead to bacterial infections.
  • Emotional Distress: The visible nature of skin lesions can lead to anxiety, depression, or social withdrawal.
  • Chronicity: Lichen planus can persist for years, requiring ongoing management.
Causes

The Precise Cause of Lichen Planus is Not Fully Understood, but Several Factors may Contribute

  • Autoimmune Response: The immune system mistakenly attacks the skin or mucous membranes.
  • Genetic Predisposition: A family history of autoimmune conditions may increase risk.
  • Triggers: Stress, certain medications, viral infections (e.g., hepatitis C), and dental materials (like amalgam) may trigger or exacerbate the condition."
Prevention
  • Avoid Known Triggers: Identifying and avoiding substances that trigger flare-ups (like certain foods or medications).
  • Stress Management: Practicing stress-reduction techniques, such as mindfulness, yoga, or therapy.
Risk Factors
  • Age: Commonly affects adults between 30 and 60 years of age, though it can occur at any age.
  • Gender: Affects both men and women, but women may be slightly more prone.
  • Autoimmune Diseases: Individuals with other autoimmune conditions, like lupus or thyroid disease, may be at higher risk.
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How is it Treated?

Treatment for Lichen Planus Focuses on Managing Symptoms and Reducing Inflammation

  • Topical Corticosteroids: Often the first line of treatment to reduce inflammation and Itching.
  • Oral Medications: In more severe cases, oral corticosteroids or immunosuppressive agents may be prescribed.
  • Antihistamines: To alleviate itching and discomfort.
  • Phototherapy: Light therapy may be beneficial in some cases.
  • Moisturizers: Regular use of emollients to soothe the skin and prevent dryness.
  • Avoidance of irritants: Discontinuing any offending medications or materials, particularly in cases affecting the mucous membranes.
  • Regular follow-ups with a healthcare provider, particularly a dermatologist, can help monitor the condition and adjust treatment as needed. While lichen planus can be chronic, many people find relief with appropriate management strategies.
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How is it Diagnosed?

Lichen planus is a chronic inflammatory condition affecting the skin, mucous membranes, nails, and scalp. Diagnosis is primarily clinical, based on the recognition of characteristic lesions—flat-topped, violaceous, polygonal papules that are often itchy. In the oral cavity, it may present as white lacy patches (Wickham’s striae) or erosive ulcers. A dermatologic or oral examination is essential, and a detailed patient history including triggers, medication use, and systemic symptoms is taken. Skin or mucosal biopsy is the gold standard for confirmation, showing band-like lymphocytic infiltrate at the dermoepidermal junction and basal cell degeneration. Direct immunofluorescence (DIF) of the biopsy specimen helps rule out other autoimmune blistering diseases.

In suspected drug-induced lichen planus, a detailed medication history is crucial. Blood tests may be ordered to screen for hepatitis C and other underlying systemic conditions linked to lichen planus. Regular monitoring is essential due to a small risk of malignant transformation in oral lesions.

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