Lichen planus

Definition:
Lichen planus is a chronic mucocutaneous disease that affects the skin, tongue, and oral mucosa. The disease presents itself in the form of papules, lesions, or rashes. Lichen planus does not involve lichens; the name refers to the appearance of affected skin. It is sometimes associated with certain medications and diseases, but is basically of unknown cause.
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Atrophic lichen planus.

Lichen planus 1

Lichen planus 2
About one in 50 people may develop the condition, which most commonly affects those between the ages of 30 and 60, and women slightly more often than men. It’s rare for children or older people to be troubled by lichen planus, though not impossible.

Classification:-
Lichen planus may be divided into the following types:

Configuration
——————-
*Annular lichen planus
*Linear lichen planus

Morphology of lesion
——————————-
*Hypertrophic lichen planus
*Atrophic lichen planus
*Vesiculobullous lichen planus
*Ulcerative lichen planus
*Follicular lichen planus
*Actinic lichen planus
*Lichen planus pigmentosus

Site of involvement
—————————-
*Lichen planus of the palms and soles (Palmoplantar lichen planus)
*Mucosal lichen planus
*Lichen planus of the nails
*Lichen planus of the scalp ( leading to cicatricial alopecia)
*Inverse lichen planus

Special forms
———————
*Drug-induced lichen planus
*Lupus erythematosus-lichen planus overlap syndrome
*Lichen planus pemphigoides
*Keratosis lichenoides chronica
*Lichenoid reaction of graft-versus-host disease
*Lichenoid keratosis
*Lichenoid dermatitis

Symptoms:
The onset of the rash is usually gradual, often first appearing on the flexor surface of the limbs (i.e. the wrists or back of knees).

After a few days the rash becomes more widespread, and it may continue to spread for several weeks. LP may also affect the genitalia and the mucous membranes (including the mouth, larynx, tonsils, conjunctivae of the eye, the bladder, vulva and vagina, throughout the gastrointestinal tract and around the anus.)

The spots of lichen planus are flat topped and pink-purple in colour, and usually measure between 3mm and 5mm. Their surface is shiny and reflects light. They may appear in groups or along the line of an injury where the skin has been knocked or scratched.

Affected skin may become raised or hypertrophic, or thin (atrophic). Hypertrophic lesions are particularly itchy.

When looked at closely, irregular white streaks can be seen. These help to identify the spots as lichen planus and are called Wickham’s striae. The spots of lichen planus can be found in the skin creases of the wrists, elbows and ankles, and in the lower back and genital areas.

The Wickham’s striae often appear in the mouth too, on the cheeks and the gums where the white milky streaks are more easily seen and create a lacy, net-like appearance. Mouth ulcers develop, causing soreness that’s made worse by hot or spicy food.

Lichen planus can affect the scalp where it destroys the hair follicles causing patches of hair loss. Nails may be affected and become thin and damaged, forming a lengthways groove along the nail.

Causes:
The cause of oral lichen planus is unknown. The lesions that appear are the result of inflammation controlled by specific white blood cells called T lymphocytes. Normally, these cells are active at the site of disease or injury.

Doctors and researchers don’t know what prompts T lymphocytes to be activated in oral lichen planus. However, certain diseases, medical conditions or other factors may act as triggers of the inflammatory disorder in some people.

It is not contagious  and does not involve any known pathogen. Some lichen planus-type rashes (known as lichenoid reactions) occur as allergic reactions to medications for high blood pressure, heart disease and arthritis, in such cases termed drug-induced lichenoid reactions. These lichenoid reactions are referred to as lichenoid mucositis (of the mucosa) or dermatitis (of the skin). Lichen planus has been reported as a complication of chronic hepatitis C virus infection and can be a sign of chronic graft-versus-host disease of the skin (Lichenoid reaction of graft-versus-host disease). It has been suggested that true lichen planus may respond to stress, where lesions may present on the mucosa or skin during times of stress in those with the disease. Lichen planus affects women more than men (at a ratio of 3:2), and occurs most often in middle-aged adults. The involvement of the mucous membranes is seen frequently and usually is asymptomatic, but occasionally, LP can be complicated by extensive painful erosions. Lichen planus in children is rare. In unpublished clinical observation, lichen planus appears to be associated with hypothyroidism in 3 young females.

Allergic reactions to amalgam fillings may contribute to the oral lesions very similar to lichen planus, and a systematic review found that many of the lesions resolved after the fillings were replaced.

Lichen planus can be part of Grinspan’s syndrome.

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Complications:

Cancer
Oral lichen planus may increase the risk of oral cancers, particularly a type known as squamous cell carcinoma. Take the following steps for cancer screening and prevention.

*Get oral cancer screenings annually or as directed by your doctor.

*If you drink alcohol, do so in moderation. Talk to your doctor to see if you should avoid alcohol completely.

*If you use any tobacco products, quit. Talk to your doctor if you need assistance ending a tobacco habit.

Esophageal problems
Lichen planus lesions in the esophagus may result in a narrowing of the esophagus or the formation of tightened, ring-like bands in the esophagus that can make swallowing difficult.

Treatment:
Care of OLP is within the scope of Oral medicine speciality. Currently there is no cure for lichen planus but there are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports that lichen planus can flare up years after it is considered cured.

Medicines used to treat lichen planus include:

*Oral and topical steroids.
*Oral retinoids
*immunosuppressant medications
*hydroxychloroquine
*tacrolimus
*dapsone

Non-drug treatments:

*UVB NarrowBand Phototherapy
*Aloe vera
*Purslane

Lifestyle and home remedies:-

In addition to regular medical and dental treatment, self-care measures may help improve your oral lichen planus symptoms or help prevent recurring episodes of severe symptoms. These include:

*Practicing good oral hygiene. Keep your mouth clean to reduce your symptoms and help prevent infection. Gently brush and floss your teeth daily. See your dentist twice a year for checkups and cleanings.

*Adjust your diet. Cut out spicy or acidic foods if they seem to trigger or worsen your symptoms.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

 

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/lichenplanus1.shtml
http://www.mayoclinic.com/health/oral-lichen-planus/DS00784/DSECTION
http://en.wikipedia.org/wiki/Lichen_planus
http://www.lichenplanus.com/app/lichen+planus.asp
http://www.uveitis.org/medical/articles/case/lichenplanus.html

 

 

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