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Lichen planus

 

Lichen planus is a non-infectious, itchy rash that can affect many areas of the body including:

  • the arms and legs
  • the mouth (oral lichen planus)
  • the nails and scalp
  • the vulva, vagina and penis

The exact cause of lichen planus is unknown. However, the condition is not infectious and it does not run in families. It cannot be passed on to other people, including sexual partners.

How common is lichen planus?

It is estimated that lichen planus affects 1-2% of the population worldwide. The condition is more common in adults over 40 years of age.

Lichen planus of the skin affects men and woman equally. However, oral lichen planus is more common among females. In around 50% of all cases of lichen planus, the mouth is affected (oral lichen planus). See Lichen planus - symptoms for more information.

Outlook

There is no single treatment that can cure lichen planus completely. However, treatments are available that can help manage and control the condition's symptoms and make living with it easier. For example, steroid creams are often used to help relieve the itch and control the rash.

Most cases of lichen planus of the skin clear up on their own within six to nine months. The rash rarely lasts longer than 18 months.

See Lichen planus - treatment for more information about the treatment options that are available for the condition.

Erosive lichen planus is a rare form of the condition that may last for a long time. It causes painful ulcers to develop in the mouth and in male and female genital areas.

See Lichen planus - complications for more information about erosive lichen planus.

 

Lichen planus of the skin usually occurs in adults over the age of 40.

The symptoms of lichen planus vary depending on which area of the body is affected. The areas of the body that can be affected by the condition include:

  • the skin
  • the mouth
  • the penis
  • the vulva (external female sex organs) and vagina

Lichen planus of the skin

The symptoms of lichen planus of the skin are:

  • purple-red coloured bumps (papules) that are slightly raised and shiny and have a flat top
  • the papules usually measure 3-5mm in diameter
  • the papules may also have irregular white streaks (Wickham's striae)
  • thicker scaly patches can appear, usually around the ankles; this is known as hypertrophic lichen planus
  • itchy skin

Lichen planus of the skin often affects the wrists, ankles and lower back, although other parts of the body can also be affected.

Thickened (hypertrophic) lichen planus affects the shins and ring-shaped lichen planus affects creases in the skin, such as the armpits. After the lesions have cleared, the affected area of skin can sometimes become discoloured.

Lichen planus of the mouth (oral lichen planus)

The symptoms of lichen planus of the mouth are:

  • a white pattern on the tongue and inner cheeks
  • white and red patches in the mouth
  • burning and discomfort in the mouth while eating or drinking
  • painful, red gums
  • recurring mouth ulcers

Mild cases of oral lichen planus do not usually cause any pain or discomfort.

Lichen planus of the penis

The symptoms of lichen planus of the penis are:

  • purple or white ring-shaped patches on the tip of the penis (glans)
  • bumps (papules) that are flat-topped and shiny
  • the rash is often not itchy

It is important to note that Lichen planus is not a sexually transitted disease.

 

Lichen planus of the vulva and vagina

The symptoms of lichen planus of the vulva and vagina include:

  • soreness, burning and rawness around the vulva
  • the vulva may be covered in white streaks and be a red, pink or pale white colour
  • if the vagina is affected, sexual intercourse can be painful
  • if the outer layers of skin break down, moist, red patches can form
  • scar tissue can form, which distorts the shape of the vagina
  • a sticky, yellow or green discharge can form, which may be bloodstained
  • the opening of the vagina can become narrowed

It is important to note that Lichen planus is not a sexually transitted disease.

Other areas

Sometimes, other areas can also be affected by lichen planus. These include:

  • the nails: these can become thinner, ridged and grooved, or they may become darker, thicker or raised; the nails may sometimes shed or stop growing
  • the scalp: red patches can appear around clusters of hair; in some cases, permanent hair loss can occur

Rarely, lichen planus of the oesophagus (gullet) and tear ducts can also occur.

Glossary

Ulcers
An ulcer is a sore break in the skin, or on the inside lining of the body.

The cause of lichen planus is unknown. However, it is thought that causes of the condition may be related to:

  • the immune system (the body's natural defence against infection and illness)
  • a reaction to certain types of medication

Autoimmune reaction

The immune system protects your body against infection and produces antibodies (proteins) that attack bacteria and viruses.

In people with lichen planus, it is thought that the immune system becomes overactive, causing an excess amount of proteins to be produced, which leads to the skin becoming inflamed. This is known as an autoimmune reaction in the body, and it causes the symptoms that are associated with the condition.

Reaction to medication

Another possible cause of lichen planus is a reaction in the body to certain medications. For example:

  • gold injections: these are disease-modifying anti-rheumatic drugs (DMARDs), which are sometimes injected into the muscles of people with arthritis to help reduce swelling (inflammation) and painful joints
  • antimalarial tablets: these help to treat and prevent malaria (a tropical disease spread by infected mosquitoes)

Lichen planus is not infectious, does not usually run in families and cannot be passed on to others.

Glossary

Anti-inflammatory
Anti-inflammatory medicines reduce swelling and inflammation.
Allergic
An allergen is a substance that reacts with the body's immune system and causes an allergic reaction.

Lichen planus of the skin

If you have lichen planus of the skin, your GP will examine the affected area and may be able to make a diagnosis based on the characteristic rash.

However, sometimes lichen planus can be mistaken for other skin conditions such as eczema, a long-term (chronic) skin condition where the skin is red, flaky, itchy and cracked.
 
If your GP is unable to make a confident diagnosis by examining your skin, they may want to take a small sample (a biopsy) of skin to examine under a microscope to help confirm a diagnosis.
 
If a skin biopsy is required, you will be given a local anaesthetic to numb the affected area so you do not feel any pain or discomfort during the procedure. 

Lichen planus of the mouth (oral lichen planus)

Oral lichen planus can be diagnosed by a dentist or a doctor. The condition is usually diagnosed by the dentist or doctor looking at the inside of your mouth.

As with lichen planus of the skin, to confirm the diagnosis, the dentist or doctor may decide to perform a biopsy by removing a sample of mouth tissue to examine under a microscope. If this is required, you will be given a local anaesthetic.

Glossary

Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.

There is no cure for lichen planus, so treatments aim to ease the symptoms and clear the rash. Mild cases of lichen planus will not require treatment. Your GP or Dentist will usually be able to treat you, however, you may need referral to a skin specialist (dermatologist) for further advice and treatment.

Lichen planus of the skin, hair and nails

There are a number of medications that may be recommended to treat lichen planus of the skin, hair and nails.

Corticosteroid creams and ointments

Creams and ointments that contain corticosteroids (artificial hormones) are often used to treat inflammatory skin conditions. Topical corticosteroids are treatments that are applied directly to a specific area of the body.It is important that they are used under medical supervision.

Corticosteroid creams and ointments help treat swelling (inflammation) and redness that is caused by lichen planus. Strong topical corticosteroids, such as clobetasol propionate, are also effective in reducing any itchiness that you may have.

Treatment is applied to the red or purple itchy spots, but should be stopped when the colour of the rash changes to brown or grey. This pigment change occurs when the inflammation has settled. Continuing to apply the corticosteroid cream to the brown areas of skin will increase the risk of the skin thinning.
 
The side effects of corticosteroids can vary depending on:

  • the type and severity of treatment being used
  • the amount of time the treatment is used for
  • the nature of the condition being treated

Potential side effects of topical corticosteroids can include:

  • redness of the skin
  • burning and stinging on the skin
  • skin rash
  • thinning of the skin (atrophy)
  • stretch marks (striae)
  • contact dermatitis: a condition that causes skin inflammation
  • perioral dermatitis: a condition that causes red lumps to develop on the face
  • acne: a skin condition that causes spots to develop on the face
  • excessive hair growth (hypertrichosis)
  • mild skin depigmentation (lightening of the skin)

As strong corticosteroid creams are often used to treat lichen planus, before starting a course of corticosteroids you should refer to the patient information leaflet that comes with your medicine to ensure that you use the correct dosage and take note of any cautions and potential side effects.
 
See the Health A-Z about topical corticosteroids (steroid creams) for more information about this type of treatment.

Corticosteroid tablets

Corticosteroid tablets are sometimes used to treat severe cases of lichen planus, when the symptoms are not being effectively controlled with creams or ointments.

Possible side effects of corticosteroid tablets that are used on a short-term basis can include:

  • an increase in appetite
  • weight gain
  • insomnia (inability to sleep)
  • fluid retention (inability to pass urine)
  • mood changes, such as feeling irritable or anxious

See corticosteroids - side effects for more information about the possible side effects of oral corticosteroids.

Other treatments that may be recommended for lichen planus of the skin are described below. 

  • Antihistamines: this type of medication is often used to treat symptoms of allergies, such as itchy skin. If you have lichen planus of the skin that is causing itchiness, antihistamines may be prescribed to help reduce this. See the Health A-Z topic on antihistamines for more information about this type of treatment. Some antihistamines can cause drowsiness so it is important not to drive or operate machinery if you experience this.
  • Lotions: moisturisers and emollients can also be effective in soothing the skin and relieving itchiness that is caused by lichen planus. See the Health A-Z topic on emollients for more information about this type of treatment. 
  • Light treatment: there are two types of light treatment - ultraviolet B (UVB) and psoralen plus ultraviolet A (PUVA). UVB is the most commonly used light treatment but PUVA may be recommended in severe or widespread cases of lichen planus that do not respond to other types of treatment. PUVA can cause side effects which your skin specialist (dermatologist) can discuss with you.
  • Acitretin: this medication is only prescribed by a specialist and is used to treat severe cases of lichen planus. The tablets have some associated side effects and may not mix well with other medicines. Your GP can advise you

Lichen planus of the mouth (oral lichen planus)

Mild cases of lichen planus of the mouth will not need any treatment. However, in more severe cases, treatment may be needed which may take the form of:

  • a mouthwash that contains an anaesthetic to temporarily numb the mouth and make eating easier
  • corticosteroid sprays, mouthwashes, pastes and dissolvable lozenges
  • a mouthwash or gel that contains an antiseptic to help prevent the build-up of plaque in your mouth
  • corticosteroid tablets may be used on a short-term basis in more severe cases of oral lichen planus

Other treatments

If corticosteroids are not effective in treating your symptoms, you may be prescribed a medication that works by suppressing your immune system to try to limit the autoimmune reaction that is thought to cause lichen planus.

These types of treatments are known as immunomodulating agents. Depending on which area of your body is affected by lichen planus, treatments that may be recommended for you could include:

  • topical immunomodulating agents: to treat lichen planus of the skin; treatments such as tacrolimus ointment and pimecrolimus cream can be rubbed directly onto the skin
  • immunomodulating agents: to treat lichen planus of the mouth; these are usually available in the form of tablets or capsules and can be used to treat severe cases of oral lichen planus

Skin pigmentation

After the lichen planus rash has cleared up, a change in skin colour may occur (a brown or grey mark), which can sometimes last for months. This is known as post-inflammatory hyperpigmentation, and tends to be more noticeable in people with darker skin.

Erosive lichen planus

Erosive lichen planus is a long-lasting (chronic) form of lichen planus that causes painful ulcers to develop and burning and discomfort in the male and female genital areas.

Occasionally, in around 2% of cases, long-term cases of erosive lichen planus can develop into certain types of cancer, for example:

Regularly examining yourself and being aware of any changes that occur will help you to identify any problems at an early stage. Pay close attention to ulcerated areas in your mouth or genitals that do not heal and persist for a long time. Visit your GP immediately if you notice any changes that you are concerned about.

You should also visit your dentist regularly to ensure that your teeth and gums remain healthy and that any ulcers or patches that form in your mouth are examined and treated promptly. Depending on individual circumstances, for adults, the recommended time for having dental check-ups is between three and 24 months.

Self-help

Below is some general self-help advice that you can follow to help ease your symptoms and prevent them getting worse.

Lichen planus of the skin

  • avoid washing with soap or bubble bath, use plain warm water instead
  • do not let affected areas of skin come into contact with shampoo by washing your hair over a basin
  • use an emollient to moisturise your skin 

Lichen planus of the mouth (oral lichen planus)

  • avoid eating spicy foods and anything acidic, such as fruit juice, as they can irritate oral lichen planus
  • avoid eating sharp food, such as crusty bread
  • avoid drinking alcohol, particularly spirits
  • if areas of your mouth are painful, stick to soft, bland foods, such as mashed potatoes and porridge
  • if possible, continue to use your usual toothpaste
  • avoid using mouthwashes that contain alcohol because they may be too strong, and keep your mouth as clean as possible
  • visit your dentist regularly to help keep your gums and teeth healthy

Lichen planus of the genitals

  • avoid washing with soap or bubble bath - use plain warm water or a soap substitute instead, such as aqueous cream
  • use an emollient, such as petroleum jelly, before and after urinating
  • applying ice packs to the affected areas may soothe itching and swelling (never apply an ice pack directly to your skin - wrap it in a clean tea towel before placing it on your body)
  • women should wear stockings instead of tight, also not wearing underwear will help avoid irritation

Glossary

Ulcers
An ulcer is a sore break in the skin, or on the inside lining of the body.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.