27/11/2025
# # # What is Lichen Planus?
Lichen Planus (LP) is a chronic, inflammatory condition that can affect the skin, hair, nails, and mucous membranes. It is not an infectious disease, meaning you cannot catch it from or spread it to someone else. It is considered an autoimmune condition, where the body's immune system mistakenly attacks its own cells.
The classic presentation is characterized by **purple, itchy, flat-topped bumps** on the skin, often with a fine, white, lacy pattern on the surface.
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# # # Symptoms by Affected Area
# # # # 1. Cutaneous (Skin) Lichen Planus
This is the most common form.
* **Appearance:** Small, flat-topped, polygonal (many-sided) bumps that are shiny and violaceous (a reddish-purple color).
* **Wickham's Striae:** A fine, white, lacy, or web-like pattern that can be seen on the surface of the bumps. This is a key diagnostic feature.
* **Itch (Pruritus):** Often severe and persistent.
* **Distribution:** Commonly appears on the **wrists, ankles, lower back, and forearms**. It can sometimes develop in areas of skin trauma, a phenomenon known as the Koebner response.
* **Healing:** After the bumps fade, they often leave behind dark brown or grayish discoloration (post-inflammatory hyperpigmentation) that can last for months.
# # # # 2. Mucosal (Mucous Membrane) Lichen Planus
This affects the moist lining of the body, most commonly the mouth and ge****ls.
* **Oral Lichen Planus:**
* **Reticular Type:** The most common form, appearing as white, lacy patches on the inside of the cheeks, gums, or tongue. It is usually painless.
* **Erosive/Atrophic Type:** Presents as painful, red, raw areas or open sores (ulcers), often surrounded by the white lacy patches. This can make eating and drinking difficult.
* **Vulvova**nal-Gingival Syndrome:** A specific form affecting the v***a, va**na, and gums simultaneously, often causing pain, redness, and scarring.
* **Pe**le Lichen Planus:** Can appear as purple or white ring-shaped patches on the g***s (head) of the p***s.
# # # # 3. Lichen Planopilaris
This affects the hair follicles on the scalp, leading to:
* Permanent hair loss (scarring alopecia).
* Redness and scaling around the hair follicles.
* Can result in permanent bald patches.
# # # # 4. Nail Lichen Planus
Affects about 10% of patients and can cause:
* Longitudinal ridging and grooving.
* Thinning and splitting of the nail plate.
* Pterygium formation (where the skin grows over the nail bed, destroying it).
* Permanent nail loss in severe cases.
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# # # Causes and Triggers
The exact cause is unknown, but it is widely accepted as an **autoimmune condition**. Specific triggers are thought to "turn on" the immune response in susceptible individuals. These can include:
* **Viral Infections:** Particularly Hepatitis C (HCV) is a well-known association.
* **Medications:** Certain drugs can trigger a Lichen Planus-like rash (lichenoid drug reaction). Common culprits include some blood pressure medications, anti-malarials, diuretics, and NSAIDs.
* **Allergens:** Contact allergens, such as certain metals, dental materials, or flavoring agents, can sometimes be a trigger.
* **Stress:** Physical or emotional stress can sometimes precede an outbreak.
* **Genetics:** A family history of LP may slightly increase the risk.
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# # # Diagnosis
A diagnosis is typically made by a **dermatologist** through:
1. **Clinical Examination:** The doctor can often diagnose it by the characteristic appearance of the rash or lesions.
2. **Skin/Mucosal Biopsy:** This is the gold standard. A small sample of the affected tissue is removed and examined under a microscope to confirm the diagnosis and rule out other conditions.
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# # # Treatment Options
There is no absolute cure for Lichen Planus, but treatments are very effective at managing symptoms, controlling outbreaks, and speeding up the healing process. The choice of treatment depends on the type and severity.
* **Topical Corticosteroids:** (e.g., clobetasol, triamcinolone) - First-line treatment to reduce inflammation and itching.
* **Intralesional Corticosteroid Injections:** Used for thicker skin lesions or stubborn oral lesions.
* **Systemic Corticosteroids:** (e.g., prednisone) - Used for short periods for severe, widespread cases.
* **Immunosuppressants:** (e.g., methotrexate, mycophenolate mofetil, cyclosporine) - For severe cases that don't respond to other treatments.
* **Retinoids:** Oral or topical forms (e.g., acitretin) can be effective.
* **Phototherapy:** (e.g., Narrowband UVB, PUVA) - Uses ultraviolet light to treat widespread skin lesions.
* **Topical Calcineurin Inhibitors:** (e.g., tacrolimus, pimecrolimus) - Used for mucosal areas, especially the face and ge****ls, to avoid the side effects of long-term steroid use.
* **Biologics:** Newer drugs that target specific parts of the immune system (e.g., apremilast) are being studied and used in some refractory cases.
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# # # Prognosis and Complications
* **Skin LP:** Often clears up on its own within **1 to 2 years**, though the discoloration may persist.
* **Mucosal LP:** Tends to be more **chronic and persistent**, lasting for many years.
* **Cancer Risk:** There is a small but increased risk of developing **squamous cell carcinoma** in long-standing erosive oral or ge***al lesions. Regular monitoring by a dermatologist or dentist is crucial.
* **Scarring:** Lichen Planopilaris (scalp) and some forms of mucosal LP can cause permanent scarring and tissue damage.
# # # When to See a Doctor
You should see a dermatologist if you develop:
* A persistent, itchy, purple rash.
* Painful sores or white, lacy patches in your mouth or on your ge****ls.
* Changes to your nails or hair loss with scalp inflammation.
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