Lichen planus: symptoms, causes & treatment options

Oral and skin problems can often be both confusing and alarming, as they may resemble other diseases or may take too long to heal. Lichen planus is one of such conditions. Though it is not contagious and cannot circulate between individuals, it could be painful, uncomfortable, or even irritating depending on its area of development. 

To some, it might just manifest as itchy bumps on the body, whereas to others, it might appear in the inside of the mouth, causing one to have difficulty eating and talking. This condition is mostly linked to the fact that the body's immune system is recognised as an allergen responsible for its skin and mucous membranes. 

It may not be life-threatening, but it can stay around for months and even years until it is treated. Because Lichen planus can take on various forms across various parts of the body, it is therefore very significant to learn the symptoms that come with it, the causes of its occurrence and how to treat it. This article defines the condition in a detailed manner and provides special forms too, including oral lichen planus and lichen planuspigmentosus.

What is lichen planus?

Lichen planus is a chronic inflammatory condition long term and affects the skin, nails, hair or the internal (internally) surface of the mouth. On the skin, it normally appears shiny, and of a flat top with bumps which may be reddish in colour, purple or even violet. Such bumps repeatedly appear together, and they are highly itchy.

Lichen planus in the mouth takes the form of white patches or open sores, or reddened and swollen tissues. The patches will resemble lacy white patterns that can result in a burning sensation. Other people might not have a lot of discomfort, but some people find it quite painful to drink liquids or eat particular foods.

The disease may also cause thinning, ridging, or, in extreme circumstances, may even cause the loss of nails. Lichen planopilaris (LPP) is a condition that causes inflammation in your scalp and hair follicles. It often causes scarring and patches of permanent hair loss, usually on your head.

The aetiology of lichen planus remains unclear. 

It is, however, believed that the system which normally protects the body against infections, the immune system, starts attacking body tissues. The abnormal reaction causes inflammation and the occurrence of lichen planus.

Symptoms and causes of lichen planus

Symptoms of lichen planus

The lichen planus varies in symptoms depending on the areas of the body where it appears. The following are the signs commonly seen:

• Skin bumps: These consist of small bumps on the skin which have a flat topping and may be purple in colour, reddish, or violet. They can combine to make bigger patches. These bumps are typically itchy, and in most cases, they leave marks after they fade.

• Itching: This is one of the most disturbing conditions that one can encounter, and it can be as mild or severe. Scratching usually exacerbates the condition and can result in scarring of the skin.
• White patches in the mouth: Wearing away occurs on the mucous membranes of the cheeks or the tongue of the mouth by forming lacy white spots. These are mostly not painful but can, at times, result in burning or tenderness such that one finds it hard to ingest certain foods.
• Mouth sores: Certain individuals develop mouth ulcers that result in pain whenever they want to consume spicy, hot and acidic foods.
• Nail changes: Ridges and grooves may grow in the nails, they become thin and even fall off. These changes will cause the nails to appear rough, brittle or disfigured with time.
• Hair loss: If the scalp is affected, there is the prospect of hair loss in small patches. The hair loss is sometimes irreversible in case it is scar-associated.
• Dark patches: The bumps could leave dark marks in the skin after they heal. This occurs more in individuals with dark skin and can take a very long period to disappear on its own.

A pathogenetic variant of lichen planus, called lichen planuspigmentosus, is predominantly brownish-grey in colour in place of the red papules. The patches are normally found on the face, underarms, and neck, and leave the skin tone looking uneven. This is predominant among those with a medium to dark colour of skin and tends not to be as itchy as the ordinary one.

Causes of lichen planus

Doctors cannot pinpoint a single cause, but a couple of factors are thought to contribute to the development of lichen planus:

• Immune system problem: The condition is believed to be an autoimmune issue. This implies that rather than combating infections, the immune system turns against its own skin or mouth tissues and causes inflammation.
• Genetics: There is a possibility of increasing it in cases where one of the family members had it or suffered from other autoimmune diseases. Genetics are not the disease; however, they can put the potential to increase the risk.
• Stress: Stress, whether physical or emotional, may elicit or aggravate lichen planus. Stress impairs the body's balance and can result in flare-ups, which involve symptoms becoming more frequent or more pronounced.
• Infections: Some viral infections may be associated with lichen planus. They are not the cause of the disease, but they could precipitate the immune reaction that initiates the disease.
• Allergic reactions: Occasionally, skin or mouth irritations that resemble lichen planus are due to sensitivity to products such as dental fillings or metals and chemicals. Taking away the stimulus normally assists in the improvement of symptoms.
• Medications: Some new medicines may sometimes cause lichen planus-like skin rashes and mouth lesions. Withdrawing or modifying the medication in consultation with medical advice will help curb the issue.

Treatment options for lichen planus

Lichen planus treatment will be targeted to minimize its symptoms, pain and avoid complications, and there is no permanent cure for it. The determination of treatment depends on how severe the condition is and where it is located.

Some of the common options include:

• Lifestyle adjustments: Foods that can cause mouth irritation, very spicy and sour foods, can also be avoided. In the case of skin involvement, they should wear loose clothing and use mild soaps that can reduce the irritation and eliminate additional damage.
• Skin care: Lotions/ creams can ease dryness and itching. Scratching should be discouraged as it not only causes scars on the body but also makes the condition worse through the transmission of bumps.
• Light therapy: Severe cases with large areas of skin can also be controlled using special light treatment. This is most often practised in a clinic and helps in lessening the itchy and bumpy skin.
• Stress management: Stress causes an attack to happen; thus, stress management through yoga, breathing exercises, or even meditation focused on reducing stress is also one way of preventing it. Less stress also helps to maintain general health and improve recovery.
• Regular follow-ups: Constant monitoring is needed by visiting the doctors to rule out rare complications, check scars and make sure the wound heals well. Early shifts in treatment can also occur as a result of consistent visits.

When individuals develop darker skin lesions, lichen planuspigmentosus treatment is most often aimed at regulating the process of inflammation and preventing the progression of discolouration, not just making them lighter.

In other cases, the condition leads to the development of thick and scaly lesions on the skin, a condition referred to as hypertrophic lichen planus. Such a kind is persistent and generally requires extended treatment and close observation to prevent scarring.

What is oral lichen planus?

When lichen planus occurs inside the mouth, it is known as oral lichen planus. This type is likely to cause more inconvenience than the skin type because eating, drinking and speaking are directly affected.

Oral lichen planus often appears as:

• White lacy patches inside the cheeks.
• Painful sores or ulcers.
• Red swollen gums or tongue.
• Sensitivity to hot, spicy, or acidic foods.

The suffering can be no pain at all, and even the inability to enjoy meals. As oral lichen planus has a long course and is likely to be recurring, it would necessitate frequent dental or medical supervision. Oral lichen planus, in rare cases, can persist indefinitely, and this can enhance the chances of getting serious problems with the mouth; thus, it is advisable to maintain it.

Diagnosis and tests

Lichen planus is most often diagnosed by appearance, but further tests may be necessary to support the results. The typical approaches contain:

• Physical examination: The doctors closely observe the skin, mouth, nails, and scalp.
• Medical history: They inquire as to the symptoms, family history, stress, or new medications to determine the possible causes.
• Biopsy: A small wound is made on the skin or mouth, and skin or mouth tissue is taken to look at under a microscope. This will assist in the confirmation of diagnosis and rule out other conditions.
• Blood tests: These may be done to exclude infections or other diseases that look similar to lichen planus.
• Allergy or patch tests: The doctors may undertake a skin test on allergic reactions in case of allergy detection.

Conclusion

Lichen planus is a long-term inflammatory disease that may involve the skin, mouth, nails or scalp. Although it is not contagious, it may provoke itching, irritation or pain which interfere with everyday life. Precisely, its cause is not fully known, but it is associated with immune system problems, stress and sometimes a reaction to infections or medications.

Although there are no actual cures, the condition is manageable through a change of lifestyle, skin care and management of stress by seeking medical advice. Some special varieties, such as lichen planuspigmentosus and hypertrophic lichen planus, are likely to require extra care, given the pigmentation or thick skin patches. Oral lichen planus must be closely monitored so as to avoid its chronicity.

It can be treated and relieved when caught early in life. When properly treated, a person with lichen planus is capable of providing self-care and living a high-quality life. Education and medical education on this condition and early medical assistance are the best steps in helping patients avoid the symptoms and lead to a quick recovery and remedy.