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Lichen planus is an extremely mysterious skin pathology that can cause swelling and irritation of the skin or mucous membranes, damage to the hair (and scalp), and disrupts nail growth. Lichen planus, when lesions are located on the skin over the body, usually looks like a purplish, itchy, flat spot or a group of spots that appear over several weeks. In the mouth, vagina, and other mucosal areas, lichen planus forms openwork white spots, sometimes with painful ulcers.
Most people can treat typical mild rashes at home with over-the-counter medications. If the condition causes pain or significant itching, you may need prescription medications. It is important to emphasize that this lichen is not contagious.
What is deprive
Lichen planus (LP) is a rare chronic disease that belongs to the category of “inflammatory autoimmune diseases of the skin and mucous membranes”. It most often appears as itchy, shiny, reddish-purple spots (lesions) on the skin (cutaneous lichen) or as a white-gray rash in the mouth or on the lips (oral). Less commonly, LP can also affect the genitals (lichen of the penis or vulva), scalp (lichen planus), ears (lichen auralis), nails, eyes, and esophagus.
Like the lichen that grows on trees and rocks in the forest, skin lesions are often flat-topped and may be somewhat scaly, hence the name lichen planus.
Lichen planus is a relatively common inflammatory disease that affects the skin and mucous membranes in the mouth, resulting in characteristic body or oral lesions.
Lichen planus usually causes itching. There seems to be a connection between the oral form and the cutaneous form of lichen planus. Nearly half of those who have mouth lesions also have skin lesions. The onset may be gradual or rapid, but the exact cause of the inflammation that leads to lichen planus has not yet been fully elucidated.
It is important to note that lichen planus itself is not an infectious disease. Therefore, this disease is not transmitted from person to person. Lichen planus is not a type of cancer.
Causes of lichen planus in adults
In most affected people, the exact cause of this type of lichen is unclear. It is hypothesized that exposure to infections, drugs, allergens, or trauma can sensitize the immune system and cause it to attack skin cells. This initial rash may persist for weeks to months, and recurrences may continue throughout a person’s life. There have been reports of LP in family members, suggesting a possible genetic predisposition, but the genetic factors for LP are still under investigation and remain uncertain.
There is limited data on how many people are affected by this lichen, but most studies estimate that LP occurs in less than 1% of the world’s population. The cutaneous form occurs with equal frequency in men and women, but women are slightly more likely to develop the oral form or lichen planus (genitals). There appears to be no racial predisposition to the disease. Most LP develops between the ages of 30 and 60, but can affect both older and younger people. In rare cases, children may be affected.
Symptoms of lichen planus in adults
Signs and symptoms of lichen last weeks or months, and periodic relapses can occur for years, flaring and fading. The appearance of lesions depends on their location.
In cutaneous LP, lesions can be present anywhere on the skin, usually on the wrists, legs, palms and soles, or trunk, and are 2 to 4 mm in diameter with angular margins, purple in color, and distinctly lustrous in transverse light. These lesions tend to be symmetrically distributed and may also coalesce into coarse scaly patches. In rare cases, blisters may form. Moderate to severe itching is common, common, and difficult to treat.
There are several variants of cutaneous LP, which can present in different ways. Lesions can become large, scaly, and warty (lichen hypertrophic), especially on the shins. New spots may appear at the site of a minor skin injury, such as a superficial scratch (Koebner phenomenon). Sometimes degeneration (atrophy) of the skin can occur while lesions persist (lichen atrophic), and in some patients there is no sweating due to degeneration of the sweat glands (anhidrosis).
In places where wounds have healed, unusual darkening (hyperpigmentation) or lightening (hypopigmentation) of the skin may occur.
Between 50 and 70% of patients show symptoms associated with mucous membranes, moist pink skin covering the inside of the mouth, vagina, and esophagus. LP on mucous membranes may appear as red, painful ulcers or lesions with a reticulate, white pattern. Oral symptoms often occur before skin lesions develop. Initially, oral symptoms may appear, consisting of dryness and a metallic taste or burning sensation in the mouth, which may be the only sign of the disease.
Hair loss, although not common, can be one of the consequences of LP, which is called planopillaris. If hair loss occurs, it can affect small patchy areas of the scalp (atrophic symmetrical alopecia) or cause bald patches (frontal fibrous alopecia). If ringworm is left untreated, hair loss becomes irreversible forever due to scarring.
A nail lesion is present in 10–25% of LP patients and tends to present as roughness, vertical ridges or cracks, and thinning of the nail. This can eventually lead to scarring of the nail.
Trouble swallowing or pain when swallowing may indicate lichen in the esophagus. It is important to treat an esophageal disease as over time this can lead to a narrowing of the esophagus, a so-called esophageal stricture.
Some cases of the cutaneous form resolve with time, while the oral, genital, nail, and esophageal forms are more persistent and may worsen over time. Patients with LP have an increased risk of squamous cell carcinoma, especially of the oral mucosa, and should be monitored periodically.
Treatment of lichen planus in adults
There are several conditions that can look very similar to lichen erythematosus and it is important to differentiate between them. Certain metals such as gold salts, arsenic, bismuth, or exposure to certain chemicals can cause a rash that is indistinguishable from LP, either oral or cutaneous.
When a patient has symptoms of lichen, doctors are likely to ask about medication history because several medications have been associated with drug-induced LP, including antimalarials (hydroxychloroquine, quinacrine, and chloroquine), blood pressure medications, proton pump inhibitors , some antibiotics, TNF inhibitors, NSAIDs (such as ibuprofen), and many others. If the rash is caused by exposure to metals, chemicals, or drugs, symptoms usually resolve after a few weeks or months of exposure, but may recur intermittently over time.
Candida is usually a harmless yeast found in the mouth, intestines, and vagina. Candidiasis (also known as a yeast infection or thrush) can occur when the host’s body creates an imbalance and malfunction of the immune system. Cadidiasis usually affects the skin or mucous membranes of the mouth, intestines, or vagina. Oral candidiasis may look similar to oral LP with white patches in the mouth. Candida infections are rarely serious in healthy people. Superficial Candida infections can occur in people with oral lichen combined with the fungus, especially in people taking topical steroids.
Other skin conditions that may be confused with lichen are psoriasis, syphilis, graft-versus-host disease, lupus affecting the skin, erythema multiforme, and erythema dyschromia persistent (ash dermatosis).
Oral LP must be distinguished from other erosive mucosal conditions such as pemphigus, pemphigoid, and recurrent aphthous ulcers. These conditions can be distinguished from LP by clinical evaluation, blood tests, and biopsy.
Diagnostics
Diagnosis can often be made by examining the skin or mucous membranes and identifying characteristic clinical signs.
If the diagnosis is unclear based on clinical findings, the doctor will usually take a small sample of skin (biopsy) to confirm the diagnosis.
There is some evidence of a link between LP (especially when taken orally) and hepatitis C virus infection, and your doctor may order a blood test. In cases where an allergy is suspected, a type of allergy test called a skin test may be helpful in determining the cause.
Modern treatments
In mild cases, symptoms may be minimal or absent, and treatment may not be required.
For patients requiring treatment, topical corticosteroids are usually the first line of therapy. They are available in many dosages and formulations, including cream, ointment, gels, solutions, mouth rinses, and others.
If topical corticosteroids are ineffective or cause side effects, a topical nonsteroidal medicine called tacrolimus or pimecrolimus may be prescribed.
Erosive lesions of the oral cavity and widespread skin rash and pruritus often require the use of systemic corticosteroids (eg, oral prednisone). Unfortunately, skin lesions may return after systemic prednisone is discontinued. In this case, the introduction of low doses of systemic corticosteroids can be continued.
Phototherapy may be useful for widespread skin disease. More severe refractory cases may require stronger immunosuppressive drugs such as mycophenolate mofetil, methotrexate, azathioprine, cyclosporine, and others.
Prevention of lichen planus at home
Although ringworm cannot be cured, some home remedies can help relieve symptoms.
Turmeric has been suggested as a remedy for lichen planus in the mouth because it has shown effects on the immune system that can help reduce the inflammation that contributes to the condition. A recent pilot study has shown promising results with this agent.
Other suggested treatments and prevention include:
- the use of certain types of oats, such as Avena sativa for baths;
- chewing sage;
- applying aloe vera gels to the skin;
- essential oils;
- borax.
But if there are exacerbations, it is better to undergo a course of treatment prescribed by a medical professional.
In general, lichen planus is not a dangerous or fatal disease. It usually resolves on its own over time, but it can persist for a long time, stretching over years, and the severity varies from patient to patient.
The presence of skin lesions is variable and can wax and wane over time. Oral lesions tend to persist longer than skin lesions. Moreover, even after complete disappearance, lichen planus may recur.
As lichen planus heals, it often leaves a dark brown color on the skin. Like the buds themselves, these spots can fade over time without treatment.
When the oral mucosa is affected by lichen planus, the risk of developing oral cancer is slightly higher. In the presence of lichen planus of the mouth, alcohol and tobacco products should be avoided, which also increase the risk.
Regular visits to a dermatologist or dentist, at least twice a year, for oral cancer screening are recommended.
Popular questions and answers
Answered questions about lichen planus doctor allergist-immunologist of the highest category, candidate of medical sciences, member of the World Allergological Organization (WAO) Ksenia Bocharova.
Is lichen planus an allergic disease?
Sometimes, certain medications, such as diuretics, can provoke the development of lichen planus. By the way, now (in connection with the coronavirus) antimalarial drugs are very actively used, they can also. Against the background of the use of antibiotics, by the way, such damage can also occur. Here, both the skin and the mucous membrane in the cavity of the mouth and genitals are damaged. There are such characteristic inflammatory elements, rashes, they are with purple papules, flat and very itchy. They can merge into plaques, scales can appear on the surface. This disease can proceed in different ways, but of course this disease does not apply to allergic ones.
Which doctor should I go to with this problem, will the diet help?
In general, dermatologists establish lichen planus on the basis of a characteristic clinical picture and a biopsy. In a tissue sample, they look for certain cell changes characteristic of this disease, because similar clinical symptoms can be given, for example, by lupus erythematosus, candidiasis, aphthous ulcers (if on the mucous membrane). On the genitals may be ankylosing spondylitis.
Is it possible to treat lichen planus with folk remedies?
With this disease – definitely to a dermatologist, for dermatoscopy and biopsy, and then only decide on the amount of therapy. Sometimes, in addition to the above methods, phototherapy will be used, but this is not just a solarium, this is a therapeutic therapy with strictly adjusted doses and wavelengths.