Definition:

Lichen planus is an auto-immune condition that tends to run a chronic course. It presents with dark, raised lesions which are flat-topped mostly affecting the skin, but also involving the oral cavity and genitals in many cases.Lichen planus is neither infectious nor contagious in nature.

The disease can affect people of any age group though it tends to be common in young adults and middle ages. Children are less commonly affected and so are old people. Lichen planus affects females more commonly as compared to males.

Variants:

Lichen planus may present in different forms in different individuals. Depending on the presentation of the lesions (and their peculiar locations), following are the variants of lichen planus that have been described:

• Hypertrophic lichen planus (Lichen planus verrucosus) – thickened lesions of lichen planus usually seen on the extremities, especially the shin. It tends to be very itchy in nature.
• Atrophic lichen planus – a rare variant of lichen planus. It is characterized by plaques with central superficial atrophy.
• Bullous or Vesiculobullous lichen planus – another rare variant of lichen planus. Vesicles and bullae (fluid-filled lesions) are seen along with the lesions of lichen planus.
• Ulcerative lichen planus – is a rare variant of lichen planus. It presents with chronic, painful bullae and ulceration of the lesions.
• Follicular lichen planus (or Lichen planopilaris) – affection of the hair follicles leading to scarring is seen. There is hair loss from the affected parts.
• Lichen planus actinicus (Actinic lichen planus) – common in Middle East countries in spring and summer. Exposed areas of the face, dorsum of hands, arms and nape of the neck develop dark, lesions with rolled edges and well defined borders.
• Lichen planus pigmentosus – another rare variant where dark-brown spots develop in sun-exposed areas and folds of the skin.
• Annular lichen planus – Commonly involves the male genitalia but also has a predilection for folds of the skin such as the axilla and groin folds and marked by small clusters of lesions.
• Linear lichen planus – lesions develop along a straight line, usually on extremities. May develop secondary to trauma (Koebner’s phenomenon).

Causes:

What exactly causes Lichen planus has not been clearly understood till.Some of the commonly cited reasons include:

• Certain cases have been linked to infections such as hepatitis C.
• Quite a few drugs such as those containing arsenic, bismuth, gold can cause a reaction like the rash of lichen planus.
• Chemicals such as those used in the development of color photographs can also produce a similar rash.
• ong-term use of drugs like quinacrine or quinidine (anti-malarial drug) may produce hypertrophic lichen planus. Some other drugs that can trigger these kind of lesions include NSAIDs (Non-steroidal anti-inflammatory drugs), certain antibiotics (Dapsone, Penicillamine, Tetracycline, Sulfonamide), medicines to treat high blood pressure (Captopril, Propranolol, Methyldopa, Enalapril), Furosemide, Allopurinol, etc.
• Stress – Intense and prolonged emotional stress such as sadness, anxiety, etc. can trigger an abnormal functioning of the immune system that can lead to Lichen planus.
• Genetic cause
• Amalgam dental fillings may trigger allergic reactions giving rise to oral lesions of lichen planus.

Symptoms:

Lichen planus can be easily identified in most cases on account of the typical location of the spots and their characteristic ‘violaceous’ appearance.

The skin eruptions of lichen planus tend to involve:

• Insides of the wrists
• Ankles
• Lower back
• Scalp
• Nails
• Mucous membranes that line the mouth, nose, genitals (vagina / penis) and anus

The onset of the eruptions can be sudden or gradual and it shows the following features:

• Rows or small clusters of flat-topped eruptions usually few millimeters in diameter
• Violaceous color of rashes in most cases; the color may vary from purple to pink to red
• Itching which may vary from mild to severe
• New eruptions may appear at sites of minor skin injury such as a superficial scratch (called as Koebner’s phenomenon)
• In some cases, there may be thick, reddish-brown lesions that are covered with scales (called as hypertrophic lichen planus)
• When the rashes resolve, they leave behind dark brown or gray spots (hyperpigmentation marks)
• In cases of scalp involvement there can be development of scarring in affected areas leading to loss of hair (alopecia areata)
• Nail affection may give rise to pits and grooves in the nails

Oral lichen planus has a typical presentation that involves:

• Small, pale, raised areas that form a lacy network on the inside of the cheeks, rarely involving the tongue; occasionally the lesions may be red and shiny
• Soreness, burning pain, tenderness – especially while taking spicy foods
• Dry mouth with metallic taste or blunted taste sensation
• Painful, recurrent ulcers in the mouth characterize one of the forms called erosive lichen planus

People with long-term lesions of lichen planus are at greater risk of developing malignancy (squamous cell carcinoma).

Diagnosis:

The patient’s symptoms, medical history and findings on examination are largely enough for the treating physician to diagnose lichen planus. Yet, there may be cases in which the early lesions resemble those of psoriasis or atopic dermatitis (in skin affection); leucoplakia or candidiasis (in oral affection), etc.

A punch biopsy may be required in such cases to confirm the diagnosis or to rule out another condition. The skin biopsy is examined under a microscope and the tell-tale appearance of the lesions confirms the diagnosis.

In cases of oral lichen planus, in order to distinguish it from whitish precancerous plaques called leukoplakia, a biopsy of the oral lesions can be very valuable.

Suggestion about homeopathic Treatment:

Homeopathy has proven efficacy in the treatment of lichen planus. Homeopathic medicines target the altered immunity of the body and bring it back to normalcy over a period of time. The treatment helps in resolution of the existing lesions, reduces the itching and controls the further spread of the lesions. Unlike conventional treatment (which includes steroids), the homeopathic treatment tends to give lasting relief to the patients.

The response to treatment depends on various factors such as duration and severity of ailments, general health of the patient, and the extent of spread of the disease.Lastly, homeopathic medicines being completely safe and free from side-effects, can be taken by the patients without any worry of experiencing adverse reactions – they are also non habit-forming. Go ahead and experience the benefits of homeopathy and treat your lichen planus effectively, safely and gently.

Self Care Tips:

• Use cool compresses to control the itching
• Keep your skin well hydrated – use oil or moisturizer over the lesions to prevent them from drying up as dry skin gets a lot more itchy
• Avoid skin injury as new lesions tend to crop up at places of injury
• Keep your nails short if your itching tends to be severe
• Take adequate measures to control stress – practice yoga, meditation, etc.
• If you know that you are sensitive to certain drugs that can cause lichen planus, make sure your doctor is aware of this. Let them prescribe you some alternative drugs whenever required.
• Avoid drinking alcohol and using tobacco products if you have lichen planus in the mouth

Visit your dentist twice a year to check for oral cancer if you have oral lichen planus