Lichen planus is a chronic inflammatory condition that affects the skin, mucous membranes, nails, and sometimes hair.

On the skin, it appears as flat-topped, purple, itchy bumps, often on the wrists, ankles, lower back, or shins. When it affects mucous membranes, such as the inside of the mouth or genital areas, it can cause white, lace-like patches, redness, or painful sores.

The condition is believed to result from an overactive immune response, although its exact cause isn’t fully understood. Certain medications, infections (like hepatitis C), or allergens may trigger lichen planus in some people.

Lichen planus is not contagious and often resolves on its own within a few months to a couple of years, but its symptoms can be bothersome and may require treatment to improve comfort and prevent complications.

Variations

Variations of lichen planus include oral lichen planus, which affects the mouth, and erosive lichen planus, a more severe form that causes ulceration.

Other types may involve the scalp, leading to hair loss (lichen planopilaris), or the nails, causing splitting or thinning.

Cutaneous Lichen Planus:

• The most common form, affecting the skin.
• Characterized by purple, polygonal, and itchy bumps.
• Often resolves after 6–18 months but may leave dark marks (hyperpigmentation).

Oral Lichen Planus:

• Affects the mucous membranes in the mouth, presenting as white, lace-like patches or red, swollen areas.
• Can cause a burning sensation, sensitivity to spicy foods, and painful sores.
• In some cases, may increase the risk of oral cancer, so regular monitoring is essential.

Genital Lichen Planus:

• Causes discomfort, redness, and ulceration in the genital region.
• More common in women and may lead to scarring if untreated.

Lichen Planopilaris:

• Affects the scalp, leading to hair loss and scarring.
• Causes redness, scaling, and follicular plugging around the hair follicles.

Nail Lichen Planus:

• Affects the nails, causing thinning, ridging, splitting, or, in severe cases, permanent nail loss.

General Interventions

Treatment depends on the severity and location of the condition. Topical corticosteroids are often used to reduce inflammation and itching. For oral lichen planus, medicated mouthwashes or systemic treatments like immunosuppressants may be needed.

Avoiding potential triggers, such as certain medications or stress, can help manage the condition. In most cases, lichen planus resolves within a year or two, though some chronic forms may persist longer.

Topical Treatments:

• Corticosteroid creams or ointments are often the first-line treatment to reduce inflammation and itching.
• Calcineurin inhibitors, such as tacrolimus or pimecrolimus, may be used for sensitive areas like the mouth or genitals.

Oral Medications:

• For severe or widespread cases, oral corticosteroids or immunosuppressive drugs (e.g., methotrexate or cyclosporine) may be prescribed.
• Antihistamines can help relieve itching.
• Retinoids (both topical and oral) may be used for persistent cases.

Mouth Rinses:

• For oral lichen planus, medicated mouthwashes containing corticosteroids or anesthetics can reduce pain and inflammation.

Phototherapy:

• Ultraviolet (UV) light therapy is effective for treating widespread skin lesions.
• This is often combined with medications for enhanced results.

Lifestyle Adjustments and Prevention:

• Avoid known triggers, such as certain medications, allergens, or irritants.
• Practice good oral hygiene to prevent exacerbation of oral lichen planus.
• For genital or oral forms, avoid spicy or acidic foods and use mild, non-irritating products.

Long-Term Management

While lichen planus often resolves on its own, recurring or chronic cases may require long-term management.

Regular checkups with a dermatologist or specialist are essential, particularly for oral or genital forms, which may have a small risk of progressing to more serious complications like cancer.

Early diagnosis and treatment can significantly improve comfort and outcomes.