|
Lichen planus Causes and Risks:
Lichen planus is a rare disorder involving a recurrent, itchy , inflammatory rash or lesion on the skin or in the mouth. The exact cause is unknown, but the disorder is likely to be related to an allergic or immune reaction. The HLA A-3 cell marker is associated with lichen
planus.
The disorder has been known to develop after exposure to potential allergens such as medications, dyes, and other chemical substances. Symptoms are increased with emotional stress , possibly because of changes in immune system functioning during stress.
Lichen planus generally occurs at or after middle age. It is very rare in the pediatric population. The initial attack may last for weeks to months, resolve, then recur for years.
Lichen planus has been associated with disorders such as bullous pemphigoid , alopecia areata, vitiligo , chronic ulcerative colitis , hypogammaglobulinemia, or graft-vs.-host reaction, and other disorders with immune response components.
Chemicals or medications associated with development of lichen planus include gold (used to treat rheumatoid arthritis ), antibiotics, arsenic, iodides, chloroquine, quinacrine, quinidine, antimony, phenothiazines, diuretics such as chlorothiazide, and many others.
Prevention:
Prevention of the disorder may not be possible. Avoiding chemicals and medications associated with lichen planus may reduce flare-ups in people with the disorder.
Symptoms:
- itching in the location of a lesion
- skin lesion
- usually located on the inner (flexor) aspects of the wrist, legs, torso, sacrum, or genitals
- generalized
- symmetric appearance
- papule 2 to 4 cm size
- papules coalesced into a plaque or large flat-topped lesion
- distinct, sharp borders to lesions
- single discrete lesion or clusters of lesions, often occur at sites of trauma
- possibly covered with fine white streaks or linear scratch marks called Wickham's striae
- shiny or scaly appearance
- color dark, reddish-purple (skin) or gray-white (mouth)
- possibility of developing blisters ( bullae ) or ulcers
- ridges in the nails ( nail abnormalities )
- dry mouth
- metallic taste in the mouth
- mouth lesions
- tender or painful (mild cases may have no discomfort)
- located on the sides of the tongue or the inside of the cheek
- occasionally located on the gums
- poorly defined area of blue-white spots or " pimples "
- linear lesions forming a lacy-appearing network of lesions
- gradual increase in size of affected area
- lesions occasionally erode to form painful ulcers
- hair loss
Signs and Tests:
A distinctive appearance of the skin lesion coupled with a history of recurrence of lesions may indicate lichen planus. The health care provider or dentist may diagnose oral lichen planus based on the distinctive appearance of mouth lesions .
A skin lesion biopsy or biopsy of a mouth lesion confirms the diagnosis.
Treatment:
Lichen planus
The goal of treatment is to reduce symptoms and speed healing of the skin lesions . If symptoms are mild, no treatment may be needed. Medications associated with triggering an outbreak should be stopped.
Antihistamines may reduce discomfort. Viscous lidocaine mouth washes may numb the area temporarily and make eating more comfortable if mouth lesions are present. Topical corticosteroids such as triamcinolone acetonide cream and/or oral corticosteroids such as prednisone are prescribed to reduce inflammation and suppress immune/ allergic response . Corticosteroids may be injected directly into a lesion. Topical retinoic acid ( Vitamin A ) cream and other anti-inflammatory or anti-pruritic ointments or creams may reduce itching and inflammation and may aid healing.
Occlusive dressings may be placed over topical medications to protect the skin from scratching.
Ultraviolet light (PUVA) therapy may be beneficial in some cases.
Prognosis:
Lichen planus is generally benign and may resolve with treatment, but can persist for months to years. Oral lichen planus usually clears within 18 months. Recurrence is common. Over 50% of people who have lichen planus on the skin also have lesions in the mouth. Lichen planus lesions may precede development of squamous cell cancers.
Complications:
Lichen planus
Call Your Healthcare Provider:
Call your health care provider if symptoms persist or if there are changes in the appearance of skin or oral lesions.
Call for an appointment with your health care provider if oral lichen planus persists of worsens despite treatment; or if your dentist recommends adjustment of medications or treatment of conditions that trigger the disorder.
Lichen planus - close-up: Lichen planus is an intensely itchy (pruritic) inflammatory lesion of the skin. The lesions are generally violaceous (red-purple), slightly raised bumps (papules) with fine scales. The papules may run together (coalesce) to form a larger raised surface (plaque). This is a condition usually seen in adults, although it can occur in children.
Lichen nitidus consists of tiny flesh colored to pink raised lesions (papules). The papules are asymptomatic but persist for long periods of time. They generally occur only on the abdomen, flexor surfaces of the elbows and palms, and on the male genitalia.
Lichen nitidus on the penis: Lichen nitidus consists of tiny flesh colored to pink papules which are asymptomatic but persist for long periods of time. They generally occur only on the abdomen, flexor surfaces of the elbows and palms, and on the male genitalia.
Lichen planus, bullous on the legs: Lichen planus is generally seen in healthy individuals. It is an inflammatory skin disease that begins as small red bumps (papules) that coalesce to form rough scaly patches which itch.
Lichen planus on the face: Lichen planus is generally seen in healthy individuals. It is an inflammatory skin disease that begins as small red bumps (papules) that coalesce to form rough scaly patches which itch.
Lichen planus on the oral mucosa: Oral lichen planus occurs in about half of the people who have lichen planus on their skin. It consists of painless whitish streaks on the mucous membranes. Other presentations are possible, and when ulceration occurs the lesions do become painful.
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously over a period of months. This condition is seen frequently in children less than 16 years old, but also occurs in adults.
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously over a period of months. This condition is seen frequently in children less than 16 years old, but also occurs in adults.
The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham's striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age.
The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham's striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age. This is a less common variant, shown here with scales.
Oral lichen planus occurs in about half of the people who have lichen planus on their skin. It consists of painless, whitish streaks on the mucous membranes. This may also produce ulcers, which are usually painful.
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously (without medication) over a period of months. This condition is seen frequently in children less than 16 years old, but may also occur in adults.
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. It clears over a period of months without needing treatment. This condition is seen frequently in children less than 16 years old but, also occurs in adults.
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously over a period of months. This condition is seen frequently in children less than 16 years old, but also occurs in adults.
|
