Lichen Planus: what it is, causes, symptoms, diagnosis and possible treatments

By Cristiano Antonino On Feb 20, 2023

Lichen Planus is a disease that causes inflammation and has the ability to impair the healthy state of the skin as well as the mucous membrane

What is Lichen Planus?

The latter usually tends to occur as flattened, red pustules that cause itching.

It mainly occurs on the area

of the upper and lower joints;
of the back;
of the oral cavity;
of the nails;
of the scalp;
of the genital organs;

Superficial to the mucous membrane, on the other hand, involves contractures and pustules of a whitish hue inside the oral cavity or vagina, resulting in an unpleasant discomfort.

This disease is not transmissible, not even through sexual intercourse, and arises at the moment when the immune defences initiate aggression against the skin and mucous membrane cells.

The motive for this unknown discomfort is not familiar, although it tends to be analysed on the basis of a medical history and specific tests for skin rashes.

Mild nuisances tend to be easily cured and often, do not require prolonged curative treatment, although there are no pharmacological products that attest to assured cure.

When the symptoms become preponderant, curative treatment involves the use of pharmacological products that can instantly kill the immune response.

Causes of Lichen Planus

The motive for the outbreak of lichen planus appears to be unknown today, although it is said to be related to the unknown response of the immune defences, which tend to be forced into action following stimulation by pharmacological products and other factors.

The problem appears to be autoimmune, and thus related to the organism itself, albeit erroneously.

However, the condition does not appear to be transmissible. The contractures appear to be present as a result of inflammation followed by white blood cells, T lymphocytes, although it is not yet known what triggers these cells within the lichen planus.

However, it is conceivable that, inflammation is a consequence of:

Pharmacological products;
Dental complexes;
Graft-versus-host disease;
Hepatitis B, C and primary biliary cholangitis;

It tends to affect 1% of individuals, although it is more frequent in women between the ages of 50 and 70.

Occurrence in children is rather sporadic.

There is coexistence with the hepatitis C virus, although lichen planus sufferers often have not coexisted with the HCV virus.

Symptoms of Lichen Planus

Symptoms related to this condition differ depending on the affected area, i.e. skin, oral cavity, genitalia, vulva and vagina.

Skin

In cases where this problem affects the skin area, the most perceptible symptoms are

Presence of flattened, red pustules spreading along areas of the body, especially in the area of the inner forearm, wrists and ankles. Further areas most affected by lichen planus are the area under the back, neck and lower limbs;
They often occur where skin folds or spots are present or in areas affected by contractures;
They are usually covered with whitish, thickened streaks;
Compromised skin causes itching;
Pustules often cause the formation of scabs and blisters;
Contractures do not cause scarring, except in cases of excessive rubbing;
After the contractures have been removed, it is possible for the skin to appear brown, a shade that soon afterwards goes away;

Oral cavity

In cases where lichen planus compromises the healthy state of the oral cavity, symptoms present:

Whitish spots or whitish spots occurring on the inner cheek area, gum area, lips and tongue;
The presence of red spots is sporadic;
Ulcers may form within the oral cavity, resulting in burning;
Subjects usually experience discomfort when drinking and swallowing food;
In mild cases, it does not involve any symptoms and tends to be noted during visits to dentists.

Genitals

This disease occurs in the genital area causing:

Whitish and red contractures that especially affect the superficial part of the genitals;
Flattened papules;
Skin rashes;
In more problematic cases, it causes lichen scleroatrophicus to take over.

Vulva and vagina

Lichen planus takes over the female private parts causing:

Red and whitish contractures resulting in itching;
Contractures causing superficial pain and burning within the vaginal mucous membranes, especially during sexual moments;
In the most problematic factors, it causes scarring resulting in ulcers and the discharge of greenish-yellow fluid from the vaginal area.

Scalp

This condition tends to compromise the healthy state of the scalp sporadically.

In cases where it occurs, it is related to flat lichen.

It tends to occur mainly in women between the ages of 40 and 60.

It causes hair loss, with inflammation of the follicle and subsequent itching and uncomfortable pain.

Nail

Lichen planus is quite sporadic, although it tends to cause nail problems, resulting in:

Furrow formation;
Nail brittleness, thickening and therefore loss;
Shade modification;

For this reason, it is advisable to seek specialist advice where contractures occur and where the symptoms are related to lichen.

Symptoms of Lichen Planus

Following the emergence of skin contractures, it is possible to highlight the presence of spots of different shades of colour, tending to greyish and brown, with prolonged periods of time.

Lichen planus contractures superficial to the vulva and vagina do not have benevolent results from treatment and are difficult to treat.

The discomfort causes contractures and prolonged changes within the vulvovaginal tissues, resulting in scar formation.

The itching, pain and burning are contiguous. The discomfort results in pain during sex and thus sexual problems.

Further studies show that this condition increases the occurrence of cancer.

Possible cures

This skin-damaging condition persists for several months.

It usually disappears on its own, although it is often appropriate to use curative treatments to remove the itch and thus boost skin care.

This condition compromises the healthy state of the mucous membranes, genitals, scalp and nails, resulting in insecurity and symptoms that are rather difficult to keep at bay.

Contractures, above all, have a chronic and progressive curative treatment and therefore often tend to persist for life.

The use of corticosteroids makes it possible to reduce the inflammation associated with lichen planus and thus the symptoms, especially the itching.

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The side effects differ depending on the use of ointments to be placed on the skin or mucous membranes or, conversely, following the use of capsules depending on the timing and problems associated with it.

The beneficial properties of corticosteroids require careful study in conjunction with side effects, such as:

Topical use

as the use of corticosteroids leads to:

Redness and burning;
Erythema and dermatitis;
Skin thickening;
Hypertrichosis;
Shifting of tone;

Oral use and injections

as the use of corticosteroids causes:

Increased appetite and body weight;
Insomnia;
Water retention;
Humoral modification;
Ospeoporosis, diabetes, hypertension, high cholesterol;

Further pharmacological products with the ability to relieve itching and pain are antihistamines.

Optimal for removing cutaneous lichen planus turns out to be phototherapy, which is of two types, although the community one involves the use of ultraviolet rays that allow the primary surface of the skin to be penetrated.

Further therapy involves the use of UVA rays that allow them to go deeper and tend to be preferred in order to combat more preponderated and propagated contractures.

There are also adverse therapeutic treatments used in the most severe lichen planus conditions, with the use of retinoids, which are used to carry out topical curative treatments that are essential in order to obviate the occurrence of pregnancies in the body of the therapy and thus resulting in foetal malformations.

Finally, immunosuppressive pharmacological products are optimal for lowering the immune response.

Tacrolimus and pimecrolimus are favoured.

If, on the other hand, the lichen planus forms are mild, curative therapies should not be used. In contrast, when the symptoms are more predominant, it is advantageous to use mouthwashes with an anaesthetic and antiseptic function or cortisone compresses with an anti-inflammatory action.

The use of cortisone-based capsules is recommended for individuals with acute lichen planus

In order to reduce the itching and inflammation caused by lichen planus, it is advisable to resort to different treatments, including:

Colloidal oatmeal baths in order to obviate the use of strong, foaming soaps and detergents;
Hot compresses in order to soften the skin or cool compresses in order to reduce itching and inflammation;
Wearing tight clothing on affected areas;
Use emollient ointments;

Where the problem is oral, it is appropriate to:

Abolish nicotine consumption;
Lower or reduce drinking of alcoholic beverages;
Avoid eating sour and spicy foods, which cause irritation of the oral mucosa;
Treating the cleanliness of the oral cavity, obviating the use of foaming toothpastes;
Obviating the use of alcohol-based mouthwashes;

Diagnosis

The specialist usually intercepts the problem after seeing the problem and on the basis of the symptoms that the subject exhibits during the examination.

However, it is often appropriate to carry out a biopsy with incision in order to ascertain the prognosis and the different motive.

During this treatment, the dermatology specialist uses a round instrument to remove a small amount of skin of approximately 6 mm.

The operation involves localised anaesthesia and subsequent closure with stitches.

However, further tests are often required in order to perceive the problems associated with lichen planus.

Following prognosis, testing for hepatitis C is used.

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