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Lichen planus

 

Lichen planus is a condition that forms an itchy rash on the skin or in the mouth.

Causes

The exact cause of lichen planus is unknown. It may be related to an allergic or immune reaction.

Risks for the condition include:

  • Exposure to certain medicines, dyes, and other chemicals (including gold, antibiotics, arsenic, iodides, chloroquine, quinacrine, quinide, phenothiazines, and diuretics)
  • Diseases such as hepatitis C

Lichen planus mostly affects middle-aged adults. It is less common in children.

Symptoms

 

Mouth sores are one symptom of lichen planus. They:

  • May be tender or painful (mild cases may not cause pain)
  • Are located on the sides of the tongue, inside of the cheek, or on the gums
  • Look like bluish-white spots or pimples
  • Form lines in a lacy network
  • Gradually increase in size
  • Sometimes form painful ulcers

Skin sores are another symptom of lichen planus. They:

  • Usually appear on the inner wrist, legs, torso, or genitals
  • Are itchy
  • Have even sides (symmetrical) and sharp borders
  • Occur alone or in clusters, often at the site of a skin injury
  • May be covered with thin white streaks or scratch marks
  • Are shiny or scaly looking
  • Have a dark, violet color
  • May develop blisters or ulcers

Other symptoms of lichen planus are:

  • Dry mouth
  • Hair loss
  • Metallic taste in the mouth
  • Ridges in the nails

 

Exams and Tests

 

Your health care provider may make the diagnosis based on the appearance of your skin or mouth lesions.

A skin lesion biopsy or biopsy of a mouth lesion can confirm the diagnosis.

 

Treatment

 

The goal of treatment is to reduce symptoms and speed healing. If your symptoms are mild, you may not need treatment.

Treatments may include:

  • Antihistamines
  • Medicines that calm down the immune system (in severe cases)
  • Lidocaine mouthwashes to numb the area and make eating more comfortable (for mouth sores)
  • Topical corticosteroids or oral corticosteroids to reduce swelling and lower immune responses
  • Corticosteroid shots into a sore
  • Vitamin A as a cream or taken by mouth
  • Other medicines that are applied to the skin
  • Dressings placed over your skin with medicines to keep you from scratching
  • Ultraviolet light therapy

 

Outlook (Prognosis)

 

Lichen planus is usually not harmful. Most often it gets better with treatment. The condition often clears up within 18 months, but may come and go for years.

If lichen planus is caused by a medicine you are taking, the rash should go away once you stop the medicine.

 

Possible Complications

 

Mouth ulcers that are present for a long time may develop into oral cancer.

 

When to Contact a Medical Professional

 

Call your provider if:

  • Your skin or mouth lesions change in appearance
  • The condition continues or gets worse, even with treatment
  • Your dentist recommends changing your medicines or treating conditions that trigger the disorder

 

 

References

James WD, Berger TG, Elston DM. Lichen planus and related conditions. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin. 12th ed. Philadelphia, PA: Elsevier; 2016:chap 12.

Patterson JW. The lichenoid reaction pattern ('interface dermatitis'). In: Patterson JW, ed. Weedon's Skin Pathology. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap 3.

 
  • Lichen planus - close-up

    Lichen planus - close-up - illustration

    Lichen planus is an intensely itchy (pruritic) inflammatory lesion of the skin. The lesions are generally violaceous (red-purple), slightly raised bumps (papules) with fine scales. The papules may run together (coalesce) to form a larger raised surface (plaque). This is a condition usually seen in adults, although it can occur in children.

    Lichen planus - close-up

    illustration

  • Lichen nitidus on the abdomen

    Lichen nitidus on the abdomen - illustration

    Lichen nitidus consists of tiny flesh colored to pink raised lesions (papules). The papules are asymptomatic but persist for long periods of time. They generally occur only on the abdomen, flexor surfaces of the elbows and palms, and on the male genitalia.

    Lichen nitidus on the abdomen

    illustration

  • Lichen planus on the arm

    Lichen planus on the arm - illustration

    The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham's striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age.

    Lichen planus on the arm

    illustration

  • Lichen planus on the hands

    Lichen planus on the hands - illustration

    The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham's striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age. This is a less common variant, shown here with scales.

    Lichen planus on the hands

    illustration

  • Lichen planus on the oral mucosa

    Lichen planus on the oral mucosa - illustration

    Oral lichen planus occurs in about half of the people who have lichen planus on their skin. It consists of painless, whitish streaks on the mucous membranes. This may also produce ulcers, which are usually painful.

    Lichen planus on the oral mucosa

    illustration

  • Lichen striatus - close-up

    Lichen striatus - close-up - illustration

    Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously (without medication) over a period of months. This condition is seen frequently in children less than 16 years old, but may also occur in adults.

    Lichen striatus - close-up

    illustration

  • Lichen striatus on the leg

    Lichen striatus on the leg - illustration

    Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. It clears over a period of months without needing treatment. This condition is seen frequently in children less than 16 years old but, also occurs in adults.

    Lichen striatus on the leg

    illustration

  • Lichen striatus - close-up

    Lichen striatus - close-up - illustration

    Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously over a period of months. This condition is seen frequently in children less than 16 years old, but also occurs in adults.

    Lichen striatus - close-up

    illustration

    • Lichen planus - close-up

      Lichen planus - close-up - illustration

      Lichen planus is an intensely itchy (pruritic) inflammatory lesion of the skin. The lesions are generally violaceous (red-purple), slightly raised bumps (papules) with fine scales. The papules may run together (coalesce) to form a larger raised surface (plaque). This is a condition usually seen in adults, although it can occur in children.

      Lichen planus - close-up

      illustration

    • Lichen nitidus on the abdomen

      Lichen nitidus on the abdomen - illustration

      Lichen nitidus consists of tiny flesh colored to pink raised lesions (papules). The papules are asymptomatic but persist for long periods of time. They generally occur only on the abdomen, flexor surfaces of the elbows and palms, and on the male genitalia.

      Lichen nitidus on the abdomen

      illustration

    • Lichen planus on the arm

      Lichen planus on the arm - illustration

      The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham's striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age.

      Lichen planus on the arm

      illustration

    • Lichen planus on the hands

      Lichen planus on the hands - illustration

      The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham's striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age. This is a less common variant, shown here with scales.

      Lichen planus on the hands

      illustration

    • Lichen planus on the oral mucosa

      Lichen planus on the oral mucosa - illustration

      Oral lichen planus occurs in about half of the people who have lichen planus on their skin. It consists of painless, whitish streaks on the mucous membranes. This may also produce ulcers, which are usually painful.

      Lichen planus on the oral mucosa

      illustration

    • Lichen striatus - close-up

      Lichen striatus - close-up - illustration

      Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously (without medication) over a period of months. This condition is seen frequently in children less than 16 years old, but may also occur in adults.

      Lichen striatus - close-up

      illustration

    • Lichen striatus on the leg

      Lichen striatus on the leg - illustration

      Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. It clears over a period of months without needing treatment. This condition is seen frequently in children less than 16 years old but, also occurs in adults.

      Lichen striatus on the leg

      illustration

    • Lichen striatus - close-up

      Lichen striatus - close-up - illustration

      Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously over a period of months. This condition is seen frequently in children less than 16 years old, but also occurs in adults.

      Lichen striatus - close-up

      illustration

    A Closer Look

     

      Tests for Lichen planus

       

         

        Review Date: 10/24/2016

        Reviewed By: David L. Swanson, MD, Vice Chair of Medical Dermatology, Associate Professor of Dermatology, Mayo Medical School, Scottsdale, AZ. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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