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, they typically appear 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.

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.

Penile lichen planus

In this condition, shiny flat-topped bumps are usually present on the penis, often occuring around the tip (glans). Sometimes, these bumps can form rings. If the skin’s outer layers break down, these areas can present as moist and red, which are known as erosions, but the erosive form of lichen planus is less common in men than in women. Sexual intercourse may be extremely painful, or 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 carefully 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.

While all types of eczema can cause distress, some may present more serious issues than others if left untreated, or if treated improperly.

Scratching or otherwise interfering with eczema may cause infection or other complications, so it is important to seek medical advice if the condition persists or worsens.

It may be reassuring to those suffering with lichen planus to know that it will usually go away on its own, and that there are online support resources that may prove helpful, like UK Lichen Planus.