What is Lichen Planus?

Lichen Planus is a skin condition that causes inflammation, resulting in the appearance of flat, purplish, itchy bumps or patches. It can affect not only the skin but also the mucous membranes (like inside the mouth or genital areas) and sometimes the nails. The exact cause is unclear, but it is believed to be related to an immune system disorder, where the body’s immune cells mistakenly attack healthy skin and mucous tissues.

What Age / Sex is prone to get affected with the Lichen Planus?

Age Affected:

• Most commonly affected: Adults aged 30 to 60 years.
• Less common in children: Lichen Planus is rare in younger individuals.

Sex Affected:

• Slightly more common in women: Women, especially those who are postmenopausal, may be more likely to develop Lichen Planus.
• Men can also be affected, though it’s seen slightly less often in men compared to women.

What is the Classification of Lichen Planus?

Lichen Planus can be classified based on the site of involvement and the appearance of lesions. Here are the main classifications:

1. Based on Site of Involvement:

• Cutaneous (Skin) Lichen Planus: The most common form, affecting the skin. Lesions typically appear on the wrists, ankles, lower back, and genital area.
• Oral Lichen Planus: Affects the mucous membranes inside the mouth. It causes white, lacy patches or sores.
• Genital Lichen Planus: Involves the genital areas, both in men and women, causing painful lesions.
• Nail Lichen Planus: Affects the nails, causing thinning, ridging, or loss of nails.
• Scalp Lichen Planus: Affects the scalp, leading to hair loss (alopecia) and scalp scarring.
• Esophageal Lichen Planus: Rare, but can affect the esophagus, causing swallowing difficulty or pain.

2. Based on Appearance of Lesions:

• Classical Lichen Planus: The typical presentation with purple, flat-topped, itchy bumps that may have a shiny surface.
• Hypertrophic Lichen Planus: Characterized by thickened, scaly lesions, often found on the shins or lower legs.
• Atrophic Lichen Planus: Involves thinning of the skin, often leaving scars after lesions heal.
• Bullous Lichen Planus: Rare form where large, fluid-filled blisters (bullae) form.
• Linear Lichen Planus: Presents as straight lines of lesions, often following skin trauma (such as scratching).
• Annular Lichen Planus: Forms ring-shaped lesions with a clearer center.

3. Other Forms:

• Lichen Planus Pigmentosus: A rare variant where dark spots or patches develop, mostly on the face or neck, with less inflammation.
• Lichen Planopilaris: A type of lichen planus that specifically affects the hair follicles, leading to hair loss and scarring.

Each type of Lichen Planus may require a different treatment approach, and its presentation can vary from person to person.

What are the Causes of Lichen Planus?

The exact cause of Lichen Planus (LP) is not fully understood, but it is believed to be related to an autoimmune response, where the immune system mistakenly attacks the body’s own skin and mucous membranes. Various factors may contribute to the development of Lichen Planus, and these include:

1. Immune System Dysfunction:

• Lichen Planus is considered an autoimmune condition, meaning the body’s immune system mistakenly targets its own tissues, particularly the skin and mucous membranes.
• T-cells (a type of white blood cell) are believed to play a role in causing inflammation and damage to the skin cells, leading to the characteristic rash.

2. Genetic Factors:

• A family history of Lichen Planus can increase the risk of developing the condition, suggesting a genetic predisposition.
• Certain genetic markers may make individuals more susceptible to the disease.

3. Infections:

• Hepatitis C Virus (HCV): There is a known association between Lichen Planus and Hepatitis C infection. People with chronic Hepatitis C are at higher risk for developing Lichen Planus.
• Other viral infections, like Herpes Simplex or Human Papillomavirus (HPV), may also contribute in some cases.

4. Medications:

• Some medications have been linked to triggering Lichen Planus in susceptible individuals, including:
  
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen)
  • Beta-blockers (used for heart conditions)
  • ACE inhibitors (used for high blood pressure)
  • Thiazide diuretics (used for fluid retention)
  • Antimalarial drugs (e.g., chloroquine)
  • Certain vaccines or antibiotics

5. Trauma or Injury (Koebner Phenomenon):

• Lichen Planus may appear in areas of the skin that have been subjected to trauma or injury, such as cuts, scratches, or sunburn. This is known as the Koebner phenomenon, where lesions form in areas of skin trauma.

6. Stress:

• While the direct link between stress and Lichen Planus is not fully established, psychological stress is thought to play a role in triggering or worsening the condition in some individuals.

7. Hormonal Changes:

• Hormonal factors may influence the development of Lichen Planus, especially in women. The condition is often more common in postmenopausal women and may be linked to changes in hormone levels.
• Hormonal fluctuations during pregnancy or the use of oral contraceptives may also affect the disease course.

8. Environmental Factors:

• Exposure to certain chemicals, such as those in cosmetics, dyes, or perfumes, may trigger Lichen Planus in susceptible individuals.
• Allergic reactions to substances like certain metals (e.g., gold, silver, or mercury) may also be contributing factors.

9. Underlying Health Conditions:

• Conditions like diabetes or high blood pressure may increase the risk of Lichen Planus.
• In some cases, autoimmune diseases like lupus or vitiligo may be associated with an increased risk.

How can we differentiate lichen planus from psoriasis?

Lichen Planus (LP) and Psoriasis are both inflammatory skin conditions that can cause similar symptoms, but they have key differences in their appearance, causes, and treatment:

How common is Lichen Planus?

Lichen Planus (LP) is considered a relatively rare condition, though it is still fairly common among certain groups of people. Its exact prevalence is not definitively known, but here are some key points about its occurrence:

• Estimated Prevalence: Lichen Planus is thought to affect 0.1% to 4% of the general population worldwide. It is more commonly seen in adults between the ages of 30 and 60.

• Gender: It occurs slightly more often in women than men, particularly in postmenopausal women, though it can affect both sexes equally.

• Age: While Lichen Planus can affect individuals of any age, it is most common in adults. It is relatively rare in children and elderly individuals.

• Oral Lichen Planus: Oral involvement, which can cause painful mouth sores, is more common in middle-aged adults, and it is believed to affect about 1-2% of the general population. This form is particularly more common in women.

• Geographic Variation: The condition is seen worldwide, but its prevalence may vary slightly between different regions and ethnic groups. It is more commonly reported in Caucasians compared to other populations.

How it affects my body?

Lichen Planus (LP) can affect various parts of the body in different ways:

1. Skin: Flat, purple, itchy bumps or patches, often on the wrists, ankles, and lower back. It can cause scarring.
2. Mouth: White, lacy patches or painful ulcers inside the mouth, causing discomfort when eating or speaking.
3. Nails: Thinning, ridging, or loss of nails in severe cases.
4. Genitals: Painful sores or ulcers, which can cause discomfort during urination or sex. Scarring may occur.
5. Scalp: Hair loss (alopecia) due to scarring, with inflammation and itching.
6. Esophagus: Rarely, it can cause difficulty swallowing.
7. Psychological Effects: Visible lesions can cause stress, anxiety, and low self-esteem.
8. Systemic Effects: Linked to autoimmune diseases, and may cause fatigue or malaise.

What are the Signs and Symptoms of Lichen Planus?

Signs and symptoms of Lichen Planus (LP) can vary depending on the area affected. Here’s a breakdown:

1. Skin:

• Purple, flat-topped bumps or patches.
• Itching: Intense itching is common.
• Lacy white pattern (Wickham’s striae) may appear, especially in the mouth or on lesions.
• Scales: Fine, dry scaling that may peel off.

2. Mouth (Oral Lichen Planus):

• White, lacy patches or sores inside the mouth.
• Painful ulcers that may cause a burning or stinging sensation, especially when eating or drinking.
• Dry mouth or difficulty swallowing (in severe cases).

3. Genitals:

• Painful sores or lesions on genital areas.
• Discomfort during urination or sexual activity.
• Scarring may occur over time.

4. Nails:

• Thinning, ridging, or splitting of nails.
• Nail loss or deformation in more severe cases.

5. Scalp:

• Hair loss (alopecia) due to scarring of hair follicles.
• Itching and inflammation on the scalp.

6. Other Symptoms:

• Fatigue or general discomfort.
• Emotional distress: Due to the visible appearance of lesions, causing anxiety or low self-esteem.

What is prognosis of Lichen Planus?

Lichen Planus (LP) is a chronic autoimmune condition, meaning it can persist for a long time, with flare-ups and periods of improvement. Here’s a more detailed but concise breakdown of the prognosis:

1. Skin LP:

   • Usually clears up within 18 months to 2 years, but it can recur. Treatment helps manage symptoms, and many people experience significant improvement over time.

2. Oral LP:

   • Tends to be persistent and may last years. It may improve, but the mouth sores can cause ongoing pain or discomfort. There’s a small risk of developing oral cancer in the long term, so regular monitoring is important.

3. Nail and Scalp LP:

   • Nail involvement can cause permanent changes, like thinning or ridging, and can be slow to improve.
   • Scalp involvement may result in permanent hair loss due to scarring, leading to bald patches.

4. Genital LP:

   • LP in the genital area can cause scarring, which may lead to long-term discomfort or narrowing of the vaginal opening in women. However, treatment can reduce symptoms.

5. Treatment and Management:

   • Most people can manage symptoms effectively with topical steroids, oral medications, and immune-modulating therapies. Though it’s often a long-term condition, treatment can control flare-ups and improve quality of life.

What are the Complications of Lichen Planus?

Complications of Lichen Planus (LP) can arise, especially if left untreated or if the condition is severe. Here are the main potential complications:

1. Scarring:

   • LP, especially when it affects the skin, scalp, and genitals, can cause scarring. This may lead to permanent hair loss (in scalp LP), nail deformities, and narrowing of the vaginal opening (in genital LP).

2. Oral Cancer Risk:

   • Oral Lichen Planus, particularly in its erosive form, can increase the risk of oral cancer. Regular check-ups and monitoring are essential to detect any changes early.

3. Infections:

   • The open sores or ulcers in LP, particularly in the mouth or genitals, can be susceptible to infections, which can complicate healing and cause further discomfort.

4. Psychological Impact:

   • The visible lesions and discomfort from LP, especially on visible areas like the skin or in the mouth, can lead to anxiety, depression, or low self-esteem. The chronic nature of the condition can also be emotionally taxing.

5. Chronic Pain and Discomfort:

   • The painful sores or ulcers in the mouth or genital areas can cause ongoing discomfort, affecting everyday activities like eating, speaking, or sexual intercourse.

6. Permanent Nail and Hair Loss:

   • Scarring of the nails can lead to long-term deformity, and hair loss on the scalp may be permanent in some cases, leading to lasting cosmetic changes.

7. Autoimmune Disease Association:

   • LP is an autoimmune condition, and people with LP may also have a higher likelihood of developing other autoimmune diseases, such as lupus or vitiligo.

What Investigations are advised in cases of Lichen Planus?

1. Clinical Examination:

• A doctor will start by examining the characteristic rash or lesions on the skin, nails, mucous membranes (oral/genital), and scalp.
• The appearance and distribution of the lesions are often enough to suggest LP.

2. Skin Biopsy:

• A skin biopsy is often performed if the diagnosis is uncertain. A small sample of the affected skin is removed and examined under a microscope.
• The biopsy typically shows specific features of LP, such as hyperkeratosis (thickened skin), basal cell degeneration, and lymphocyte infiltration.

3. Oral Biopsy:

• If oral LP is suspected, a biopsy of the affected mucous membrane in the mouth can be done to confirm the diagnosis.
• The biopsy may show similar characteristics to skin LP, such as white lacy lesions or erosions.

4. Blood Tests:

• Hepatitis C testing: Since LP is associated with Hepatitis C in some cases, testing for Hepatitis C virus (HCV) may be recommended.
• Complete blood count (CBC): To rule out other conditions or assess for any underlying infections.
• Autoimmune markers: If there’s a suspicion of other autoimmune diseases, tests for markers like anti-nuclear antibodies (ANA) may be conducted.

5. Wood’s Lamp Examination:

• This test uses UV light to examine the skin for any subtle signs of LP that might not be easily visible with regular lighting.

6. Patch Testing:

• If an allergic reaction is suspected to be triggering LP, patch testing (to check for allergens) may be recommended, especially if there’s a history of new lesions after exposure to certain substances.

7. Histopathology:

• Microscopic examination of biopsy tissue helps to identify specific patterns of inflammation, which are typical in Lichen Planus. This is one of the most definitive tests.

8. Other Imaging (rare):

• In rare cases, imaging or further tests might be needed if LP affects deeper tissues or causes complications, but this is not usually required.

What Diet/management is advised in cases of Lichen Planus?

Self-care can help to deal with lichen planus in easier ways:

• Anti-inflammatory Diet:

  • An anti-inflammatory diet rich in fruits, vegetables, and whole grains may help manage symptoms and promote overall health. Some people find that avoiding spicy, acidic, or hot foods reduces irritation in the mouth.

• Avoiding Triggers:

  • Some individuals may experience flare-ups due to stress, certain medications, or allergens. Identifying and avoiding triggers, such as specific foods or skin irritants, can be beneficial.

• Gentle Skin Care:

  • Use mild, fragrance-free soaps and moisturizers to avoid irritating the skin. Avoid scratching affected areas to prevent further skin damage or infection.

• Oral Care:

  • Good oral hygiene is important to prevent infections in the mouth. Use a soft toothbrush and avoid harsh toothpaste, especially if you have oral LP.

• Stress Management:

  • Since stress can exacerbate LP, engaging in stress-reducing activities like yoga, meditation, or deep breathing exercises may help manage flare-ups.

• Smoking and Alcohol:

  • Smoking and excessive alcohol intake can trigger or worsen symptoms, so it is advisable to avoid them.

What is the commonly indicated Homeopathic treatment for Lichen Planus?

Homeopathic medicines can help in management of the symptoms of Lichen Planus. Below are the homeopathic remedies that are commonly prescribed:

1. Arsenicum album: This remedy is indicated where there is intense itching and scratching makes the situation worse. Skin may appear dry, rough, and flaky, with scaly patches. The symptoms may get worse at night, especially the itching. Individuals who may have underlying anxiety about their health, often worrying about death or serious conditions.
2. Arsenicum Iodatum: Ars Iod is prescribed when the person has been suffering from lichen planus for a prolonged period, with persistent lesions. Itching may be associated with a burning sensation, often worse at night, and scratching may make the symptoms feel worse. The lesions might have a tendency to ulcerate or break open.
3.  Apis: Apis is prescribed when the lesions might be swollen, red, and puffy, especially if there is fluid accumulation or a sense of puffiness around the affected area. Individuals may find relief when applying cold compresses or being in cool environments. The person may feel a burning or stinging pain, often with the desire to scratch, but scratching may worsen the condition.
4. Borax: Borax is indicated if the lichen planus lesions tend to ulcerate or become sore and tender. The affected areas may be extremely sensitive to touch, and the person may feel discomfort or pain even with light pressure on the skin. The individual might also experience an overall sense of dryness in the mouth or skin.
5. Sulphur: Sulphur is often used for individuals with chronic skin issues or those who seem to have a tendency to develop skin eruption. The skin is dry, flaky, and inflamed, especially if these symptoms seem to be getting progressively worse. The lesions might be very dry, scaly, and inflamed, with a tendency for the skin to become cracked and sore. In some cases, Sulphur can be indicated if the lesions are oozing or have a discharge with an offensive, unpleasant odor.

Disclaimer: The information provided is for educational purposes only and should not be construed as medical advice. Always consult a qualified healthcare professional or physician before starting any treatment or using any medication. Self-medication without professional guidance can be harmful to your health. The content provided here is not intended to replace professional medical advice, diagnosis, or treatment.