What is lichen planus?
![Lichen Planus](https://images.medicinenet.com/images/Article/main_image/lichen-planus-skin-outbreak-condition-torso-body.jpg?output-quality=75)
Lichen planus is a chronic recurrent inflammatory disorder of the skin and mucous membranes. It is characterized by small, flat-topped, polygonal bumps that may coalesce into rough, scaly plaques on the skin. There may also be involvement of the lining tissue (mucous membranes) of the mouth and/or vagina.
Lichen planus is a poorly understood skin condition. Its name is descriptive in that to some it resembles a simple plant, a lichen, which grows on rocks and tree bark, while planus is Latin for flat.
What are causes and risk factors for lichen planus?
The cause of lichen planus is unknown. In certain locales, patients with extensive lichen planus seem to be more likely to have a hepatitis C virus infection of the liver. However, it seems unlikely that the virus is the cause of lichen planus in such situations.
Some drugs, such as those containing arsenic, bismuth, or gold, can produce an eruption that appears identical to lichen planus. Exposure to certain chemicals used in the development of color photographs can also produce a similar rash. The long-term use of the drugs quinacrine or quinidine (Quinidine Gluconate, Quinidine Sulfate), may produce hypertrophic lichen planus of the lower legs.
Lichenoid eruptions can occur in graft-versus-host disease in people who have received bone marrow transplants. Tissue examination by a pathologist (biopsy) is frequently necessary to distinguish such lichenoid drug eruptions from classical lichen planus. Of course, stopping the offending drug is associated with the resolution of the eruption.
How is the rash of lichen planus different from that of most other common rashes?
Lichen planus can be distinguished from eczema, psoriasis, and other common rashes purely based on its clinical appearance in that lesions are small bumps or aggregations of bumps that are flat-topped, shiny, polygonal, and purple to gray. They tend to occur at the wrists and elbows and ankles.
Individual papules contain thin white lines called Wickham's striae. When lichen planus involves mucosal tissues, such as the lips or cheeks, these white filmy, web-like lines are easy to detect. It is not unusual for lichen planus to appear at sites of trauma, especially along lines of scratches (excoriations).
What are symptoms and signs of lichen planus?
Lichen planus itching varies from mild to severe.
The onset of lichen planus can be sudden or gradual. The first attack may last for weeks or months, and recurrences may happen for years. The bumps at first are 2 mm-4 mm in diameter, with angular borders and violet color. An excess of pigment (hyperpigmentation) may develop in the affected skin as the lesions persist.
- If lichen planus involves the scalp, it can permanently damage the hair follicles, producing a patch of bald skin called lichen planopilaris.
- If lichen planus involves the finger or toenails, scarring often occurs, producing permanently malformed nails.
- Ulcerative lichen planus may occur if oral or vaginal lining tissue (mucosa) is involved.
What does lichen planus look like?
The appearance of lichen planus depends on whether the skin or the lining (mucous membranes) inside the mouth or vagina is affected:
- Skin involvement: The usual skin involvement with lichen planus consists of flat-topped lilac or violet to brown spots a few millimeters in diameter on the skin. These spots tend to be located on the inner wrists, forearms, lower legs just above the ankles, and the lower part of the back.
- A variant of this disease is called hypertrophic lichen planus. This condition appears as thick, reddish-brown lesions that are covered with scales. These spots tend to be on the shins, but they can occur anywhere on the body. This is an especially itchy and persistent (chronic) variant of lichen planus.
- Atrophic lichen planus produces slightly depressed lesions that otherwise resemble typical lichen planus.
- Mucous membranes: Lichen planus of the mucous membranes of the mouth and genitals is common. It appears as a white, lacy rash on the inside of the cheeks or the vagina and may not cause symptoms. The oral rash often occurs before any skin involvement. More troublesome, although rare, is erosive lichen planus, which can be quite sore and uncomfortable. This erosive form typically causes the patient to complain of shallow and often quite painful, recurrent ulcers in the mouth or genitals. Lichen planus of the female genitalia can involve the external vulvar mucosa and the internal vaginal mucosa. There is an association with cancer in these areas, so both the oral and vaginal tissues need to be monitored by a medical professional.
- Nail malformation may be produced by lichen planus.
- Lichen planus may involve the scalp, producing a permanent, scarring type of balding.
What physicians diagnose and treat lichen planus?
Most dermatologists, gynecologists, and some oral surgeons diagnose and treat lichen planus.
How do healthcare professionals diagnose lichen planus?
Usually, lichen planus is relatively straightforward to diagnose. Physicians can make the diagnosis in typical cases simply by looking at the rash. If necessary, a skin biopsy may be done to help confirm the diagnosis because, under the microscope, lichen planus is distinctive in appearance.
Because several other lichenoid eruptions resemble lichen planus a biopsy confirmation is frequently necessary. Persistent oral or vaginal lichen planus, with spots that thicken and grow together, can sometimes be difficult to distinguish clinically from whitish precancerous plaques called leukoplakia. A biopsy can be helpful in this situation.
Ulcerative lichen planus precedes the development of oral cancer in a few patients.
![](https://images.medicinenet.com//images/slideshow/common-adult-skin-problems-s1-photo-of-freckled-young-woman.jpg)
SLIDESHOW
Rosacea, Acne, Shingles, Covid-19 Rashes: Common Adult Skin Diseases See SlideshowWhat is the treatment for lichen planus?
Most lichen planus is relatively mild. Affected individuals who do not have symptoms do not need treatment. Ultimately, there is no agreed-upon cure for this condition.
Topical corticosteroid creams or topical calcineurin inhibitors like tacrolimus or pimecrolimus may alleviate the itch and rash. For localized, itchy, thick lesions, injections of corticosteroids directly into the plaque may help. Antihistamines may blunt the itch, particularly if it is only moderate. This effect is in part due to the sedative effect of antihistamines. For oral lesions, topical steroids (cortisone) in special oral preparations are available.
In more severe lichen planus, physicians may recommend oral medications or therapy with ultraviolet light. Oral medications may include a course of oral prednisone or acitretin or griseofulvin. Occasionally, other immunosuppressive agents may be employed. However, the itching may return after the drug has been discontinued. A low-dose oral corticosteroid every other morning also may be prescribed. For painful lesions within the mouth, special mouthwashes containing a painkiller (such as lidocaine) before meals may provide some relief. Any drug or chemical suspected of being the cause of the lichen planus should be discontinued.
Are there home remedies for lichen planus?
Although there is little objective evidence of its benefits, green tea has been suggested as a treatment for lichen planus. It is likely to be a safe approach.
What is the long-term prognosis of lichen planus?
Lichen planus usually goes away by itself in time. Some drugs can produce rashes that are similar in appearance to lichen planus. These rashes can be distinguished from lichen planus in that they go away when the offending drug is stopped.
Le Cleach, Laurence, and Olivier Chosidow. “Lichen Planus.” The New England Journal of Medicine 366 (2012): 723-732.
Lehman, J.S. "Lichen Planus." International Journal of Dermatology 48.7 (2009): 682-694.
"Lichen Planus." DermNet NZ. October 2015. <http://dermnetnz.org/scaly/lichen-planus.html>.
Sharma, Amit, et al. "Lichen Planus: An Update and Review." Pediatric Dermatology 90 July 2012: 17-23.
Weston, Gillian, and Michael Payette. "Update on Lichen Planus and Its Clinical Variants." International Journal of Women's Dermatology 1 (2015): 140-149.
Top Lichen Planus Related Articles
Skin Diseases: 15 Uncommon Skin Conditions
Genetic illnesses, health conditions, or infections cause your skin to react in unusual ways. Learn about these conditions and what they can do to skin.8 Skin Warning Signs to Worry About in a Rash
Most of the rashes are harmless and may not indicate anything serious. However, if there are these accompanying symptoms along with the skin rash, it may signify something serious.A rash can become serious if immediate medical assistance is not provided when a patient has the below symptoms including rash covers most of the body, continuous itching, fever, and difficulty breathing
Are Skin Rashes Contagious?
Direct and indirect contact can spread some types of rashes from person to person. Rash treatment depends upon a rash's underlying cause. A rash that sheds large amounts of skin warrants urgent medical attention. Rashes can be either contagious or noncontagious. Noncontagious rashes include seborrheic dermatitis, atopic dermatitis, contact dermatitis, stasis dermatitis, psoriasis, nummular eczema, drug eruptions, hives, heat rash (miliaria), and diaper rash. Rashes usually considered contagious include molluscum contagiosum (viral), impetigo (bacterial), herpes (herpes simplex, types 1 and 2 viruses), rash caused by Neisseria meningitides (N. meningitides) (bacterial), rash and blisters that accompany shingles (herpes zoster virus), ringworm (fungal) infections (tinea), scabies (itch mite), chickenpox (viral), measles and rubella (viral), erythema infectiosum (viral), pityriasis rosea (viral), cellulitis and erysipelas (bacterial), lymphangitis (bacterial, and folliculitis (bacterial).Hepatitis C (HCV, Hep C)
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by blood transfusion, hemodialysis, and needle sticks, especially with intravenous drug abuse. Symptoms of chronic hepatitis include fatigue, fever, muscle aches, loss of appetite, and fever. Chronic hepatitis C may be cured in most individuals with drugs that target specific genomes of hepatitis C.Itching (Pruritus)
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching including infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.Lichen Planus (Oral) Picture
Lichen planus (LP) is a chronic recurrent inflammatory disorder of the skin and mucous membranes. It is characterized by small, flat-topped, polygonal bumps that may coalesce into rough, scaly plaques on the skin. Oral lichen planus. Tongue of a 68-year-old woman with lichen planus, showing white patches. This condition affects middle-aged adults, but has an unknown cause. In some cases it may be of nervous or emotional origin (such as severe stress) but in others it may be an allergic reaction or due to drugs.Skin Rash
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.Skin Biopsy
During a skin biopsy, a piece of skin is removed under a local anesthesia and examined using a microscope. The different types of skin biopsy include shave biopsy, punch biopsy, and excisional biopsy. Skin biopsies are performed to diagnose skin growths, skin conditions, and skin cancers.Skin Infections
Viruses, bacteria, and fungi can all cause skin infections. What is scabies? Learn about golden staph infections, cellulitis, impetigo, fifth disease, leprosy, and more. See photos of infections like chickenpox, athlete’s foot, and candida, a fungal yeast skin infection.Kids' Skin Problems
What are the most common skin rashes in children? Learn about childhood eczema, ring worm, chicken pox and more. Get the facts on treatment for childhood skin problems.Skin Test for Allergy
An allergy skin test helps identify triggers for one's allergic reactions. Small amounts of allergy-provoking substances (allergens) are scratched into the skin. Redness and swelling develop if one is allergic to the substance. A positive allergy skin test implies that the person has an IgE antibody response to that substance. The test is rapid, simple, and relatively safe.The Skin: 7 Most Important Layers and Functions
The skin is the largest organ in the body and it covers the body's entire external surface. It is made up of seven layers. The first five layers form the epidermis, which is the outermost, thick layer of the skin. The hypodermis is the deepest layer of skin situated below the dermis.Tongue Problems
There are a variety of diseases and conditions that can cause tongue problems, discoloration, and soreness. Though most tongue problems are not serious. Conditions such as leukoplakia, oral thrush, and oral lichen planus may cause a white tongue while Kawasaki syndrome, scarlet fever, and geographic tongue may cause the tongue to appear red. A black hairy tongue may be caused by overgrown papillae on the tongue. Canker sores, smoking, and trauma may cause soreness of the tongue.Mouth Problems: TMJ, Canker Sores, Painful Gums and More
Sores, painful gums, bad breath -- what's going on in your mouth? Find out with our slideshow of the most common mouth problems. Learn about canker sores, cold sores, oral thrush, TMJ, and oral cancer. See what treatments for bad breath and other dental problems are available from your dentist.What Are the Types of Skin Lesions?
A skin lesion is an abnormal growth or rash on the skin as compared to normal skin. There are two main categories of skin lesions: primary and secondary lesions. Primary skin lesions are abnormal skin conditions that may be present at birth or acquired later. Secondary skin lesions are a result of irritated or manipulated primary skin lesions.