Lichen planus (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.

Overview
Lichen planus is a disease in which there is an itchy rash on the skin or in the mouth.

What are the symptoms of Lichen planus?

 * Mouth lesions:
 * Tender or painful (mild cases may have no discomfort)
 * Located on the sides of the tongue or the inside of the cheek
 * Sometimes located on the gums
 * Area of blue-white spots or "pimples"
 * Lines of lesions that form a lacy-looking network
 * Gradual increase in size of the affected area
 * Lesions sometimes form painful ulcers


 * Skin lesions:
 * Usually located on the inner wrist, legs, torso, or genitals
 * Itchy
 * Even on both sides (symmetrical)
 * Single lesion or clusters of lesions, often at sites of skin injury
 * Papule 2 - 4 cm in size
 * Papules clustered into a large, flat-topped lesion
 * Lesions have distinct, sharp borders
 * Possibly covered with fine white streaks or scratch marks called Wickham's striae
 * Shiny or scaly appearance
 * Dark colored - reddish-purple (skin) or gray-white (mouth)
 * Possibility of developing blisters or ulcers


 * Other symptoms include:
 * Dry mouth
 * Hair loss
 * Metallic taste in the mouth
 * Ridges in the nails (nail abnormalities)

What causes Lichen planus?

 * The exact cause of lichen planus is unknown. However, it is likely to be related to an allergic or immune reaction.


 * Lichen planus generally affects middle-aged adults. It is less common in children.

Who is at highest risk?
Risks include:
 * Exposure to medications, dyes, and other chemical substances (including gold, antibiotics, arsenic, iodides, chloroquine, quinacrine, quinide, phenothiazines, and diuretics)
 * Disorders such as hepatitis C

When to seek urgent medical care?
Call your health care provider if:
 * Your symptoms continue
 * The skin or mouth lesions change in appearance
 * The condition continues or worsens even with treatment
 * Your dentist recommends adjusting your medications or treating conditions that trigger the disorder

Diagnosis

 * The health care provider may make the diagnosis based on the appearance of the skin or mouth lesions.


 * A skin lesion biopsy or biopsy of a mouth lesion can confirm the diagnosis.


 * Blood tests may be done to rule out hepatitis.

Treatment options

 * The goal of treatment is to reduce your symptoms and speed healing of the skin lesions.


 * If symptoms are mild, you may not need treatment.


 * Treatments may include:
 * Antihistamines
 * Immune-suppressing medications, such as cyclosporine (in severe cases)
 * Lidocaine mouthwashes: to numb the area and make eating more comfortable (for mouth lesions)
 * Topical corticosteroids (such as clobetasol) or oral corticosteroids (such as prednisone): to reduce swelling and suppress immune responses. :*Corticosteroids may be injected right into a lesion.
 * Topical retinoic acid cream (a form of vitamin A) and other ointments or creams: to reduce itching and swelling and aid healing
 * Topical immune-suppressing medications, such as tacrolimus and pimecroliumus but lesions must be watched carefully for signs of cancer
 * Dressings may be placed over topical medications to protect the skin from scratching.
 * Ultraviolet light therapy may be helpful in some cases.
 * Oral retinoids (acitretin)

Where to find medical care for Lichen planus?
Directions to Hospitals Treating Lichen planus

What to expect (Outlook/Prognosis)?

 * Lichen planus is usually not harmful and may get better with treatment. It usually clears up within 18 months.


 * However it may last for weeks to months, and may come and go for years. It usually clears up within 18 months.


 * If lichen planus is caused by a medication, the rash should go away once the medicine is stopped.

Possible complications
Mouth ulcers that are there for a long time may develop into oral cancer.

Source
http://www.nlm.nih.gov/medlineplus/ency/article/000867.htm