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Lichen Planus

Lichen planus is a condition that can affect different parts of the body, including the inside of the mouth, or in the hair, nails or mucous membranes, where it can cause swelling and irritation.

Anyone can develop lichen planus, but it most often affects adults over 30, and the oral form most frequently affects women between 35-45.

Lichen planus on the skin usually resolves on its own within 6-9 months, but can last for many years, and the rash and itching characteristic of the condition may require patients to use creams and ointments. If the condition doesn’t respond to over-the-counter treatments, it may be necessary to obtain prescription strength treatment from a GP.

Lichen planus in the mouth can last for several years, or even for life. The GP can prescribe mouthwashes and sprays to help relieve common symptoms such as burning or sore gums.

Lichen planus is not contagious, and once it resolves, it does not usually recur.

While lichen planus can affect the mucous membranes and skin around the genitals, it is not a sexually transmitted infection (STI), but it is sometimes erroneously conflated with one, which can be upsetting or embarrassing for patients.

While lichen planus itself isn’t generally a serious health risk, as a result of the chronic and often sore condition, many patients find that it negatively impacts their quality of life, their abilities to perform daily tasks, and their self-confidence.

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Lichen Planus

Lichen planus on the skin usually resolves on its own within 6-9 months, but can last for many years, and the rash and itching characteristic of the condition may require patients to use creams and ointments.

If the condition doesn’t respond to over-the-counter treatments, it may be necessary to obtain prescription strength treatment from a GP.

Symptoms of Lichen Planus

Depending on where lichen planus presents on the body, the symptoms might be different, and you may have it in one place and not another.
On the skin, lichen planus usually appears as purplish, itchy, flat bumps that develop over several weeks. In the mouth, vagina or other areas covered by a mucous membrane, lichen planus forms lacy white patches, sometimes accompanied by painful sores.
Lichen Planus of the Skin
This will usually appear as shiny purplish flat-topped bumps of different sizes, which develop over several weeks. They may feature tiny white lines called Wickham’s striae, and can be very itchy. While lichen planus can appear anywhere on the skin, it typically appears on inner wrists, forearms and ankles, and new lesions often appear while others seem to be clearing up. Sometimes after the skin has cleared up, it remains discoloured in the place where a lesion previously was, and this discolouration can remain for some time, but usually returns to normal eventually. Scratching lichen planus can result in complications like infection or scarring, so it is best to resist scratching, even though it is itchy.
Oral Lichen Planus
Almost half of lichen planus cases involve the mouth, and often the mouth is the only area affected. Oral lichen planus can present as white or red patches, white streaks, ulcers or painful and even inflamed red gums. The condition may be asymptomatic, or only be sore occasionally. Certain foods that are spicy, acidic or hard in texture may worsen the soreness, as may alcohol.

Patient leaflet (British Association of Dermatologists)

Oral lichen planus
Vulval Lichen Planus
Although it is possible to have painless white streaks as the only feature in the vulva, the more painful erosive lichen planus is more common. Erosive lichen planus can affect the vulva, the labia minora, the entrance to the vagina and also deep inside the vagina. Areas that are affected become very irritated, sore and red. If the skin’s outer layers break down, these areas can present as moist and red, which are known as erosions. Sometimes the condition can cause a sticky yellow discharge, which may be streaked with blood. Sexual intercourse can be extremely painful, and even impossible, which may result in emotional and psychological issues as well as physical ones.
Other Areas of the Body
Lichen planus can less commonly involve the fingernails or toenails, the hair and the skin of the scalp, or the skin around the anus. In some extremely rare instances, the condition can involve the oesophagus or tear ducts.
While it’s best to visit the GP to treat the symptoms of lichen planus, and they may advise more specific at-home care routines to manage the bout, there are some generally accepted ways of treating the condition, wherever it might appear on the body, for example:
On the Skin
When washing the affected area, avoid soaps or body washes, and instead use plain warm water. When washing the hair, it may be best to lean over a sink or the side of the bath, so that shampoo doesn’t come into contact with the rest of the skin. It will also probably be advisable to use an emollient (moisturising treatment) on the affected skin. Your pharmacist should be able to advise which type of cream will be best, or your doctor or dermatologist may prescribe a cream to help soothe the condition.
On the Vulva
It may be beneficial to use petroleum jelly on the affected area before going to the toilet, and it is wise to avoid wearing anything but breathable cotton undergarments. Tights should be avoided. Sometimes if the itching and swelling are severe, it may help to wrap a clean towel around a bag of ice or frozen peas, and gently hold this against the area for no longer than 20 minutes in order to reduce swelling and ease the itching.
In the Mouth

Using a soft-bristled toothbrush, remember to brush the teeth carefully twice daily in order to keep the teeth and gums healthy, and reduce the risk of further complications. Salty, spicy or acidic foods may make the mouth sore, in which case they should be avoided. Similarly, alcohol may cause soreness, so it may be necessary to avoid it, as well as mouthwashes that contain it.

Causes of Lichen Planus

Lichen planus occurs when the immune system attacks the cells of the skin or mucous membranes, but it’s not clear why this abnormal immune response occurs.

Lichen planus may be triggered by underlying medical conditions, or by taking certain medications. Some common triggers include:

  • Hepatitis C infection
  • Flu vaccine
  • Certain pigments, chemicals and metals
  • Certain analgesic (pain relieving) medications containing ibuprofen
  • Certain medications used to treat heart disease, high blood pressure and arthritis

Treatment of Lichen Planus at Derma

While your GP and your pharmacist can be very helpful in diagnosing and treating cases of lichen planus, we are more than happy to see patients who prefer to consult a private dermatology specialist.

Your appointment will begin with a skin check and medical history, which will allow the dermatologist to diagnose any skin conditions that may be co-occurring.

Together with the dermatologist, you will be able to discuss the latest and most effective treatments and explain all potential side-effects, enabling you to select the best option for you.

It’s likely that lichen planus can be managed using topical treatments available from chemists, but prescription creams or tablets may be helpful to reduce itching; or necessary, if the skin has become infected from scratching.

Whatever your needs, you can rest assured that Derma will provide the very best care for your skin, with access to the latest research and treatments.

Further reading: Patient leaflet from the British Association of Dermatologists

Lichen planus

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