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LICHEN PLANUS

What is Lichen Planus ?

Lichen planus is a skin inflammation which may occur at any age. Typically it affects people between the ages of 30 and 60. Extreme skin irritation is the major symptom. There are many different forms of lichen planus. The typical rash occurs on the wrists, the inside of the forearms, and on the lower legs. The rash consists of small flat-topped bumps which have a rather unique violet colour. Some people develop a much lumpier rash on the legs, where large itchy swellings develop. If the scalp is involved, hair tends to fall out. Such hair loss is permanent. If the fingernails or toenails are affected, lichen planus causes a permanent disfigurement of those nails. Many people with lichen planus also have involvement in the mouth, with soreness in the cheeks adjacent to the back teeth. Other moist surfaces can be affected, including the vulva, the vagina and the penis. In these areas, the skin becomes very sore and may bleed.

How does Lichen Planus occur ?

Lichen planus is caused by the accumulation in the skin of certain white blood cells called lymphocytes. Why these cells accumulate is not known. However, the reaction involves the immune (body defence) system.

Why does Lichen Planus occur ?

In most cases of lichen planus, there is no obvious reason for the eruption to have come up. There is some evidence that the disorder occurs in families. The tendency to it may be inherited. Some medicines can cause a rash which is very similar to lichen planus. These include tablets taken for high blood pressure and for arthritis.

Treatment Involved for Lichen Planus

The main symptom of lichen planus is itching. If moist areas are involved, soreness in that area also develops. Treatment is therefore directed at helping the symptoms. On the skin, steroid (cortisone-like) creams are used. Quite strong steroid creams are necessary to help the itching. You will need to use these twice daily until the rash has completely disappeared. On moist areas, such as in the mouth or vagina or penis, special creams suitable for moist areas can be used. Steroid sprays may also be effective in these areas. If an attack of lichen planus is particularly severe, you may be given steroid tablets. They are started at a high dose and then gradually reduced over a period of 6 to 8 weeks. The use of steroid tablets is much more common when dealing with lichen planus affecting the mouth or other moist areas. If the scalp or nails are affected, steroid tablets are almost always used. This is because the destruction of scalp hair or nails can be permanent, and must therefore be prevented if at all possible.

During Treatment for Lichen Planus

During treatment with either steroid creams or tablets, the itching rapidly improves and the rash subsides. Very often, the skin where the rash has been will darken due to the effect of the inflammation on the pigment cells in the skin. These dark patches can become very pronounced. The dark marks will persist even once the lichen planus has been eradicated. The body eventually gets rid of them, but it may take several months or even years to clear the pigment completely from the skin. Unfortunately, no treatment can help to speed up this process. If you have been treated with steroid tablets, you may put on weight, due to fluid retention. It tends to diminish quickly once the tablets have been withdrawn. Very often, the use of the steroid tablets will cause a swelling of the face, which once again will return to normal when the tablets have been stopped. Steroid tablets can cause indigestion, diabetes and even a high blood pressure. If you develop any unusual symptoms, the doctor should be consulted.

After Treatment for Lichen Planus

Occasionally, lichen planus can become more active if either steroid tablets or creams are withdrawn suddenly. It is important that you slowly reduce the steroid tablets as directed by the doctor. The steroid creams need to be continued until the rash has completely subsided. Although rare, a second attack of lichen planus can occur.

If Lichen Planus is Left Untreated

The itching would persist. Lichen planus of the skin is generally self-limiting. It lasts between 9 and 18 months before settling of its own accord. However, failure to treat it can cause permanent disfigurement of the nails and permanent hair loss.