lichen planus

What is Lichen Planus?

Lichen planus is a chronic inflammatory condition that affects the skin, mucous membranes, and other areas of the body. It is characterized by an itchy rash or eruption on the skin or in the mouth.

Symptoms of Lichen Planus

• Inflammation (swelling and irritation) on the skin or inside the mouth
• Small, discrete, polygonal, flat-topped, violaceous papules that may coalesce to form larger patches [4]
• Tiny red spiny follicular papules and extending smooth areas on the scalp or less often, elsewhere on the body [2]
• Itchy rash on the skin or in the mouth [8]

Causes and Effects of Lichen Planus

• The exact cause of lichen planus is unknown, but it is believed to be an autoimmune disease [7]
• Lichen planus can affect various areas of the body, including the skin, oral mucosa, genital mucosa, scalp, and nails [3]
• It is a self-limited disease that usually resolves within 12-18 months, but it recurs often in about 20% of patients [6]

Types of Lichen Planus

• Lichen planopilaris: affects the scalp or less often, elsewhere on the body [2]
• Oral lichen planus: affects the mucous membranes inside the mouth [3]

References

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Common Signs and Symptoms of Lichen Planus

Lichen planus is a condition that causes skin inflammation, which can manifest in various ways depending on the affected area. Here are some common signs and symptoms:

• Skin Lesions: The most common symptom is the appearance of shiny red or purple bumps on the skin, which can be firm to the touch and may itch slightly or severely [1][2].
• Genital Area Symptoms: In women, lichen planus can cause soreness, burning, and rawness around the vulva, with white streaks covering the area [3]. Men may experience sore red patches on their penis.
• Mouth Symptoms: Oral lichen planus can appear as white, lacy patches; red, swollen tissues; or open sores in the mouth, causing discomfort and pain [4].
• Nail Symptoms: Lichen planus can also affect the nails, causing them to become rough, thinning, and developing grooves on their surface.
• Other Symptoms: In some cases, lichen planus may cause diffuse redness and peeling of the skin, as well as painful and persistent erosions and ulcers.

References:

[1] Context result 2 [2] Context result 7 [3] Context result 4 [4] Context result 5

Diagnostic Tests for Lichen Planus

Lichen planus can be diagnosed through various tests, which help confirm the presence of this condition and rule out other possible causes. Here are some common diagnostic tests used to diagnose lichen planus:

• Clinical Examination: A thorough examination by a healthcare provider or dentist is often the first step in diagnosing lichen planus. They will examine the affected skin or mucosal surfaces, looking for characteristic signs such as purplish, itchy patches and bumps.
• Biopsy: A biopsy is usually performed to confirm the diagnosis of lichen planus. This involves taking a small sample of tissue from the affected area, which is then examined under a microscope for signs of inflammation and other changes associated with lichen planus [2][4].
• Allergy Test: An allergy test may be conducted to determine if an allergic reaction is causing the lichen planus flare-up. This can help identify potential allergens that need to be avoided.
• Skin Biopsy: A skin biopsy is often performed on the affected area, which helps confirm the diagnosis of lichen planus and rule out other conditions [4].
• Oral Examination: For oral lichen planus, a dentist or oral surgeon will perform an examination of the mouth, looking for signs of inflammation and other changes associated with this condition.

It's worth noting that a combination of these tests may be used to confirm the diagnosis of lichen planus. A healthcare provider or dermatologist will determine which test(s) are necessary based on individual circumstances [5][6].

References: [1] Not applicable [2] by RP USATINE · 2011 · Cited by 303 — Classic cases of lichen planus may be diagnosed clinically, but a 4-mm punch biopsy is often helpful and is required for more atypical cases. [3] Not applicable [4] by L Planus — How is lichen planus diagnosed? · Allergy test. An allergy test can determine if you have an allergy that's causing your lichen planus flare-up. · Biopsy. Your ... [5] The diagnosis of lichen planus is often made by a dermatologist, oral surgeon or dentist on the basis of the typical clinical appearance. A skin biopsy may be ... [6] Learn about how dermatologists diagnose and treat lichen planus. [7] Jan 31, 2023 — A GP can usually diagnose lichen planus by examining the rash and asking about your symptoms. Oral lichen planus is often diagnosed by a dentist ...

Oral Medicines Used for Lichen Planus

Lichen planus can be treated with various oral medicines, including anti-inflammatory and immunosuppressive agents. Some of the commonly used oral medications are:

• Hydroxychloroquine (Plaquenil): An antimalarial medication that has been shown to be effective in treating lichen planus [1].
• Metronidazole: An antibiotic that may be used to treat lichen planus, particularly when there is an associated bacterial infection [1].

Corticosteroids

Corticosteroids are a class of medications that are commonly used to treat lichen planus. They can be administered orally or topically, and they work by reducing inflammation and suppressing the immune system.

• Prednisone: A corticosteroid medication that is often prescribed for severe cases of lichen planus [3][8]. The recommended dosage is typically 30-60 mg per day, with an efficacy threshold of 15-20 mg per day [8].
• Corticosteroids (e.g. prednisone): Can be used to treat lichen planus when it lasts a long time or when there are many bumps or painful sores [9].

Other Medications

In addition to corticosteroids and oral anti-infections drugs, other medications may also be used to treat lichen planus. These include:

• Antihistamines: May be used to relieve itching and other allergic symptoms associated with lichen planus [7].
• PUVA therapy: A type of light therapy that may be used to treat lichen planus when it is severe or widespread [9].

References

[1] Cribier, B. (1998). Treatments for cutaneous LP: psoralen plus UV-A therapy (conventional and bath); etretinate; acetretin; oral tretinoin; corticosteroids; griseofulvin; oral antibiotics. [Context 2]

[3] USATINE, R. P. (2011). Three to six weeks of oral prednisone therapy should be used to treat severe, widespread lichen planus (tapered course, 30 to 60 mg per day... [Context 3]

[7] L Planus. (no date). Antihistamines. Antihistamines are a class of drugs commonly used to treat allergy symptoms, including itchy skin. Hydrocortisone creams or ointments. Over-the-... [Context 7]

[8] Cribier, B. (1998). Corticosteroids remain the most widely used treatment in LP. ... Prednisone dosages of 30 to 60 mg/d are recommended, with an efficacy threshold of 15 to 20 mg/d. [Context 8]

[9] L Planus. (no date). Corticosteroid: Pills (such as prednisone) or shots can help when lichen planus lasts a long time or a patient has many bumps or painful sores. PUVA therapy: A... [Context 9]

Lichen planus (LP) is a chronic inflammatory skin condition that can be challenging to diagnose due to its varied clinical presentation and potential overlap with other dermatological conditions. The differential diagnosis for LP includes several entities, which are listed below:

• Leukoplakia: A white patch or plaque on the mucous membranes that cannot be rubbed off, often associated with chronic irritation or smoking [1].
• Candidiasis: A fungal infection that can cause a range of symptoms, including redness, itching, and white patches on the skin or mucous membranes [2].
• Erythema multiforme: An autoimmune condition characterized by target-shaped lesions on the skin, often accompanied by fever and other systemic symptoms [3].
• Pemphigus vulgaris: A chronic autoimmune blistering disease that affects the skin and mucous membranes, often associated with oral ulcers and skin blisters [4].
• Bullous pemphigoid: An autoimmune condition characterized by large blisters on the skin, often accompanied by itching and other systemic symptoms [5].
• Lichen sclerosus: A chronic inflammatory skin condition that can cause thinning of the skin, often associated with pruritus (itching) and scarring [6].
• Bite reactions: Skin lesions caused by insect bites or other minor trauma, which can mimic the appearance of LP [7].

It's essential to note that a definitive diagnosis of lichen planus is based on clinical presentation, medical history, and histopathological examination. A 4-mm punch biopsy is often recommended to confirm the diagnosis [8]. The differential diagnosis for hypertrophic lichenoid dermatitis (HLP) is also broad and encompasses numerous entities in many different categories, including premalignant and malignant conditions [9].

References:

[1] Context result 2 [2] Context result 5 [3] Context result 4 [4] Context result 6 [5] Context result 7 [6] Context result 8 [7] Context result 9 [8] Context result 3 [9] Context result 10