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Lichen planus, also referred to as LP, is an inflammatory disease that commonly occurs on the skin and in the mouth. It is known to affect approximately one to two percent of individuals.
What Lichen Planus is Not
In order to understand what Lichen Planus is, it may be easier for patients to understand what it is not. It is not infectious, is impossible to catch from someone or give to someone else, it is not hereditary, it is not cancer, and it is not related to one's diet.
What is Lichen Planus?
This condition is an inflammatory disease that can affect areas such as the skin, mouth, nails, and genital areas. It is commonly seen in middle-aged adults though the specific cause of lichen planus is unknown. Most dermatologists believe this condition is classified as an autoimmune disease which means the white blood cells of the body are fighting healthy areas of the skin instead of germs. The condition may occur due to allergic reactions of medications that are commonly used for heart disease, high blood pressure, and even the treatment of arthritis. Ceasing this medication can help clear up Lichen Planus in just a few weeks.
Lichen Planus on the Skin
This condition is typically diagnosed by the examination of red or purple colored bumps on the skin that are flat and may be itchy. It may also appear as Wickham's Striae, a lacy, white look on the skin. It can occur on areas such as the back, neck, genitals, nails, scalp, and nails. This condition is often short-lived, and while it heals, it may leave the skin discolored (dark brown staining). As with the bumps, given time, these stains will eventually fade without the need for treatment. About 20 percent of patients will suffer a second attack of LP.
Treatment of Lichen Planus
Treatment can be effective to relieve the itching and to improve the rash until it fades on its own. There is currently no cure for Lichen Planus. Most patients benefit from the use of topical creams such as corticosteroids. Stronger applications such as oral medications (cortisone and retinoids) or phototherapy may be discussed for more severe cases of Lichen Planus.
As with other skin disorders, following your dermatologist's advice is the best approach for dealing with LP. Since new areas of LP can form in damaged skin, try to avoid injury.
LICHEN PLANUS OF THE MOUTH
LP of the mouth most commonly occurs inside of the cheeks, but can affect the tongue, lips, and gum tissue. Oral LP typically lasts longer and is more difficult to treat than LP on the skin. Fortunately, many of the cases involving LP of the mouth result in minimal problems. Only about 20 percent of patients with oral LP also develop skin LP.
Oral LP normally appears as groups of dots and white lines, these typically do not cause complications. Dentists often discover them during routine dental exams. Severe forms of oral LP can result in painful sores and ulcers in the mouth. Your dermatologist may have to make sure that the sores are not caused by yeast or other infection and are not canker sores. Sometimes a biopsy of affected tissue may be needed to confirm a diagnosis. There have been cases of LP-like allergic reactions to dental materials but these cases are extremely rare. Patch testing may be used to pinpoint the allergy; removing dental material may be recommended.
TREATMENT FOR LP OF THE MOUTH
There are many treatments that eliminate the pain of sores, but there is no known cure for oral LP. When there is no pain or burning associated with the disease, treatment may not be needed. Severe forms of LP —those with burning, pain, redness, sores, blisters, and ulcers - may be treated with a variety of medications, both applied to the sores (topical steroids or topical tacrolimus) and taken by mouth (oral). As with any condition that affects the lining of the mouth, LP can cause poor dental hygiene and gum disease. Proper oral hygiene is very important. See your dentist at least twice a year for examinations and cleanings.
ARE YOU AT RISK?
Patients who have oral LP may be at a slightly elevated risk of developing oral cancer. Because of this increased risk, it is wise to discontinue the use of alcohol and tobacco products which also increase the risk. Regular visits to the dermatologist - every six to twelve months - for an oral cancer screening is recommended.
FOOD FOR THOUGHT
Spicy foods, tomato products, citrus juices, caffeinated drinks such as coffee and colas, as well as crispy foods such as corn chips and toast can aggravate LP of the mouth.
LICHEN PLANUS OF THE GENITALS
Mild cases will not experience many symptoms at all, but in more severe cases the presence of painful red areas or open sores will require treatment. There are good treatment options, so do mention genital involvement to your physician.
Nail changes have been observed in LP. Usually, only a few fingernails or toenails are involved, but occasionally all are affected. Nail changes can occur with or without skin involvement.
Nail changes associated with LP include grooving, longitudinal ridging, nail thinning, splitting, and nail loss. In some cases, the affected nails can be destroyed either temporarily or permanently.
In rare cases LP may affect areas with hair such as the scalp. This is called lichen planopilaris, and can lead to redness, irritation, and in some cases, permanent hair loss
We put academic qualifications, many years of combined experience, and training in a variety of special interest areas to work for your healthy, radiant skin. Our providers – Drs. Schachter, Hanna, Curtis, Abdulla, Pollack, and Taradash – welcome new patients for treatment at the Dermatology on Bloor practice on Park Road in Toronto. Our team is here to serve your needs