Lichen Planus

drthind_lichen planus

Lichen Planus is an uncommon inflammatory condition of skin, mouth and genitals. It is thought to be due to abnormal immune reaction provoked by a viral infection or a drug. It is usually presented as shiny itchy rash, small bumps, pink or purple in color, mouth ulcers or rash, bluish tongue or cheek.

In some cases patients experience itching and rashes of the uro-genital area. Being a chronic skin disease, it tends to last from years in most cases.
Lichen planus can affect any area, but is most often seen on the front of the wrist, lower back and ankles. On the palms and soles the papules are firm and yellow. New lesions may appear while other is clearing.
Age / Sex of Lichen Planus

Lichen Planus cases are reported between the age group of 30-60 years. It occurs equally in men and women.

Classification of Lichen Planus

• Hypertrophic Lichen Planus (Lichen planus Verrucosus)- site of onset is extremities, especially on shin bone.

• Atrophic Lichen Planus- Rare type characterized by plaques with central superficial atrophy.

• Bullous or Vesiculobullous Lichen Planus: This is also a rare type characterized by lichen planus lesions seen along the vesicles and bullae (Fluid filled lesions).

• Ulcerative Lichen Planus: It presents with chronic, painful bullae ( fluid-filled lesions) and ulceration of the lesions.

•  Follicular Lichen Planus: It affects hair follicles leading to scarring. Hair loss from affected parts is a main symptom.

• Lichen Planus Actinicus- It affects exposed areas of the face, dorsum of hand,arms and nape of the neck develop dark, lesions with rolled edges and well defined borders.

• Lichen Planus Piagmentosus- Characterized by Dark-brown spots develop in sun exposed areas and folds of the skin.

• Annular Lichen Planus- Commonly involves male genitalia but also has a predilection for folds of skin such as the axilla and groin folds and maked by small clusters of lesions.

• Linear Lichen Planus-Lesions develop along a strainght line, usually on extremities. May develop secondary to trauma.
 

Causes of Lichen Planus

Cause of lichen planus is unknown. The lesions that appear are result of inflammation controlled by specific white blood cells known as T lymphocytes. However, it may also be related to an allergic or immune reactions.
Factors that trigger Lichen planus are:
• Hepatitis B, C infection.
• Allergens( Allergy causing agents)
• Exposure to Dyes for eg.tattoo pigments.
• Nonsteriodal / anti-inflammatory drugs.
• Certain medications for heart disease, high blood pressure or arthritis.

Lichen Planus Signs and Symptoms

Skin: Eruptions of lichen planus mainly on insides of the wrists, ankles, lower back, scalp, ridges in the nails and mucous membrane of nose , mouth , genitals and anus.
Oral:  Painless white streaks located on the side of the tongue or on inner lining of the cheeks, occasionally located on the gums. Lesions occasionally form painful ulcers.
 Other Symptoms:
• Dry mouth
• Hair loss
• Metallic taste of mouth.

Prognosis of Lichen Planus

Lichen planus is usually not harmful.Condition can be treated with doctors advise and treatment based on diagnosis.

Complications of Lichen Planus

There is some evidence that lichen planus may increase the risk of certain cancers
• Squamous cell carcinoma, a type of skin cancer.
• Oral cancer
• penile carcinoma
• vulvovaginal cancer.

Investigations for Lichen Planus

In most cases a doctor can diagnose the condition from physical examination of the rash. Skin biopsy to confirm the diagnosis or to rule out another conditions.
In case of oral lichen planus, biopsy of the oral lesions is done to distinguish it from leukoplakia.

Diet / management of Lichen Planus

Self care can help to deal with lichen planus in easier ways:
• Use cool compresses to control itching.
• Keep skin hydrated( apply oil /moisturizers)
• Trim nails on regular intervals.
• Practice yoga or medication can help to control stress  level
• Avoid alcohol and tobacco products in case of Oral lesions.
• Maintain proper oral & dental hygiene.

Treatment of Lichen Planus

• Medicinal treatment like oral and topical steroids, immunosupressants, steroid cream or ointment etc are given as per doctor’s advice and depending on diagnosis of the individual.
• Non-drug treatment like UVB Narrow band Phototherapy is advised.

Homeopathic treatment for Lichen Planus

Arsenicum album:
• Used for lichen planus with itching in many parts of their body.
• Skin on abdomen and rectum are usually the itchiest area of the body.
• Skin of chest covered with small, purple bumps and spots.
• Skin is painful, swollen, shiny and covered with blisters.

Arsenicum Iodatum:
• Used in case of lichen planus, eczema and psoriasis with marked itching and exfoliation of the skin.
• Good remedy for acne, pustular and eczematous lesions especially in the beard region.

Apis:
• Prickly heat ;lichen utericatus.

Borax:
• used in case of oral lichen planus.
• Blisters in the oral cavity.

Carcinosinum:
• Used for lichen planus, vitiligo, styes and chalazion.
• It influences mind, lungs, heart, eyes, skin, bones and joints, nerves etc.

Sulphur:
• Indicated remedy for skin disorders
• Used in cases with hard, dry and flaking skin with itching especially in the evening.
• Prescribed for thin, sensitive people, with intolerance of heat.
• On psychological grounds patient is depressive / irritated, disorganized or lazy.