Lichen Planus
Lichen planus is a relatively uncommon skin condition. It is believed to come about due to an unusual immune reaction that’s provoked by a drug or a viral infection like hepatitis C. For people who suffer with lichen planus, it seems like their inflammatory cells believe that their skin cells are foreign, and then attack them.
Lichen planus typically causes skin lesions in a small area. In less frequent cases, it may affect a larger area of the skin, and sometimes the mucous membranes. In roughly 85% of cases, it will clear up from the skin within a year and a half, but is can uncommonly persist longer, particularly if it is affecting the genitals or the mouth.
The classic pattern of lichen planus is firm, flat-topped, shiny bumps that vary from the size of a pin point to almost half an inch across. They are a purplish color, and frequently display white lines across them. They can be grouped closely together or more widespread, and grouped in rings or lines.
Lichen planus can affect any part of the body, but it is seen most commonly on the ankles, lower back and fronts of the wrists. If they occur on the palms, the bumps are yellow and firm. Patches of thick and scaly skin are very itchy and are seen most often around your ankles.
New lesions sometimes appear while older ones are in the process of clearing. As the bumps clear, they may be replaced by brownish-gray areas, especially in people with darker skin. This is referred to as post-inflammatory hyper-pigmentation, and it can last for months.
Oral lichen planus causes involvement of the mouth, and it’s usually the only affected area. The sides of the tongue and the insides of the cheeks are the usual areas affected, although the lips and gums may be involved, too. You most often see painless white streaks, painful ulcers and red and peeling gums.
Sometimes the oral type of lichen planus is caused by mercury in fillings on teeth nearby. You may have an allergic reaction to the mercury, and patch testing can confirm if this is the case. If it is, then the fillings can be replaced with those made from composite materials.
Lichen planus of the erosive type usually affects the inner vaginal lips and the vagina entrance. The mucous membranes that are affected will appear raw and red. This can be quite painful, and may prevent sexual intercourse. It can also cause scarring that closes over the vagina.
Vaginal lichen planus affects membranes more deeply inside the vagina. The cells on the surface inside the vagina will peel off and give way to a mucky discharge. This type may bleed easily when touched.
Penile lichen planus usually occurs around the tip of the penis, in a ring. The erosive qualities and white streaks are less common in this type. Once in a great while, a long, persistent case of erosive lichen planus may result in skin cancer.
Your dermatologist, dentist or oral surgeon will diagnose lichen planus by its appearance. A biopsy may be used to make the initial diagnosis or to confirm it, or to check for skin cancer.
Treatment is usually done in the form of topical steroids, which are applied for four to six weeks. If the sores are in the mouth, you may use inhalant powders or steroid pastes. Hydrocortisone foam is often used for breakouts inside the vagina.
Other treatments for lichen planus include immune modulating drugs, phototherapy, oral anti-fungals and long term antibiotics. After the bumps fade, they may leave darker spots behind, that may take months to clear.
