Lichen planus is a skin disease that is also commonly known as lichen planus. The disease is manifested by inflammation that causes skin changes and is accompanied by severe itching.
What is lichen planus?
Typically, lichen planus forms pale, mostly bluish nodules on the skin. These are initially small and reach a size of two to twelve millimeters. See AbbreviationFinder for abbreviations related to Lichen Planus.
Lichen planus owes its name to the typical nodule formation on the skin. These nodules occur both singly and in dense clusters. In addition to the nodules, the skin usually also forms light stripes on the surface, which are arranged like a net. These strips are also known in medicine as Wickham strips.
The disease occurs in different parts of the body. The lichen planus often affects the mucous membranes, especially the oral mucosa. External areas of skin that are often affected are the shins, ankles, and insteps. Sometimes the scalp or nails are also affected.
The disease occurs comparatively rarely. Middle-aged people are particularly affected, between about 30 and 60 years of age. It is believed that lichen planus is an autoimmune disease. However, this assumption is not certain, as the cause of the disease has not yet been identified.
The causes responsible for the outbreak of lichen planus are not known. It can only be observed that lichen planus, as is typical for many skin diseases, can be triggered or aggravated by mechanical irritation or a skin infection.
Flare-ups can also be caused by certain drugs or chemicals. The disease also occurs more frequently after viral diseases and brings the typical skin changes to light. These could be traced back to an inflammation of the skin, which in turn is triggered by certain defense cells of the immune system below the epidermis when they attack the epidermis and dissolve the lowest cell layer.
Because of this, it is believed that lichen planus is an autoimmune disease. However, it is not yet possible to explain why these cells react in this way.
Symptoms, Ailments & Signs
Ringworm can cause symptoms on the skin, skin appendages (e.g. hair and nails) and mucous membranes. Typically, lichen planus develops pale, mostly bluish nodules. These are initially small and reach a size of two to twelve millimeters. As the disease progresses, multiple nodules combine to form a large lump or raised patches of skin.
The papules have a fine surface, which is characterized by the so-called Wickham stripes. They cause different levels of itching. Lichen planus develops predominantly on the ankles, sacrum, lower legs and in the crook of the wrist.
In the acute form, lichen planus develops into a rash over the entire body. Every tenth patient notices thinning or splitting of the nails during the course of the disease. The nails rarely fall out permanently. Hair loss can also occur, although this is usually limited to certain areas. Crusts form on the scalp and there is increased dandruff.
In a third of cases, the mucous membranes are involved. Conspicuous stripes and diffuse, mostly whitish areas then develop in the area of the mucous membranes. In isolated cases, the tongue, gums, cheek pouches and lips are affected. Nodular lichen in the genital area causes changes in the mucous membrane of the glans or the entrance to the vagina.
Diagnosis & History
Due to the typical skin changes, the diagnosis of lichen ruber planus is easy to make. To confirm the diagnosis, doctors usually carry out a blood and tissue test. Examination of the tissue sample reveals what is known as hyperkeratosis and focal granulosis of the epidermis in lichen planus. This is a disease-specific thickening of the epidermis.
In addition, the identification of defense cells and antibodies below the epidermis can be used to draw conclusions about lichen ruber planus with certainty. Even if lichen planus is not treated, in most cases the disease resolves without any apparent reason. The inflammation of the skin is often completely healed after 6 months. In 10 to 20 percent of cases, however, the disease reappears after a few years.
In other cases, the disease does not go away on its own and treatment by a doctor is necessary. Even if the prognosis is good, medical treatment is advisable, as the itching scratches many of the nodules, which often leads to scarring. In diseases of the scalp, there is also a risk that the hair follicles on the affected skin areas will be destroyed and the hair in this area will fall out completely.
In rare cases, diseased nails are also lost. Diseases of the mucous membranes can lead to serious consequences in the form of malignant tumors. Although these cases are rare and tumors usually appear after years of having lichen planus, it is advisable to seek treatment from a healthcare professional to reduce the risk of complications.
In most cases, lichen planus causes various discomforts on the patient’s skin. These can have a very negative effect on the aesthetics of those affected and often lead to inferiority complexes or reduced self-esteem. Patients suffer primarily from papules on the skin and severe itching.
The itching can also spread to neighboring regions and cause symptoms there as well. Furthermore, it comes to the formation of reddened stripes all over the skin. The quality of life of those affected is significantly reduced and restricted by lichen ruber planus. The skin also thickens, which also leads to aesthetic problems. Scratching can make itching worse. Scratching also often leads to the formation of scars.
Treatment of lichen planus usually takes place with the help of ointments and creams. There are no particular complications. It is not uncommon for patients to suffer from caries and require appropriate treatment. The life expectancy of the patient is usually not affected or reduced by lichen planus.
When should you go to the doctor?
If skin changes and other signs of lichen planus occur, you should speak to your family doctor. If there are other signs of illness, it is best to consult a doctor in the same week. Changes to the hair, nails and mucous membranes indicate a pronounced form of lichen planus, which urgently needs to be clarified. People who regularly take medication (e.g. painkillers and antibiotics) and diabetics are among the risk groups. Like patients with psoriasis and existing infections, they should consult their doctor if there are signs of a serious condition.
If lichen planus is treated early, it will subside quickly. Therefore, a doctor should be informed in any case with symptoms or a concrete suspicion. This applies in particular to people who repeatedly notice open areas in the area of skin and mucous membranes or who have already suffered from lichen planus in the past. Those affected can talk to their family doctor, dentist or dermatologist. The skin changes can cause psychological problems, which are best discussed with a psychologist.
Treatment & Therapy
No treatment is needed for lichen planus if the disease resolves on its own. In most cases, however, the symptoms are treated in order to relieve those affected from symptoms. Cortisone ointments and cortisone plasters or ointments containing tar are usually prescribed, which help to regenerate the skin and relieve itching.
In severe cases, drugs in the form of cortisone crystal solutions are injected. These are used in particular for large-scale diseases and are usually accompanied by oral intake of vitamin A acid preparations. In addition, local light therapy, such as photo-chemotherapy, can support healing. This also stops the severe itching. Antihistamines are also prescribed for this.
Even if one suspects that lichen planus is an autoimmune disease, it is not automatically treated with immunosuppressants. In rare cases, however, the use of these drugs is still necessary. The treatment of serious diseases that do not heal on their own is usually tedious and time-consuming and associated with pain for the patient. Treating the mucous membranes is particularly difficult, as caries and dentures can repeatedly lead to irritation that is counterproductive to the healing of lichen planus.
Outlook & Forecast
In general, the symptoms of lichen planus (lichen planus) persist for a longer period of one to two years and then go away on their own. However, the period of time until the conspicuousness subsides can also be significantly shorter or longer. In many cases, there are still slight changes, such as pigment disorders, even after the lichen planus has healed.
As a rule – in contrast to lichen planus verrucosus (large lichen infestation of the lower leg) – no scars are to be expected with lichen planus. In general, there are hardly any known serious consequences due to the disease. Sometimes the lichen planus can progress from the acute to the chronic form and then persist for decades. Even after healing, a recurrence must always be expected.
Although there is still disagreement among scientists, according to the WHO (World Health Organization), lichen planus is a precursor to precancerous skin cancer when it comes to diseases in the oral cavity. However, only very few patients with lichen planus develop oral cancer. However, since the possibility of developing cancer cannot be ruled out, regular check-ups should be carried out every few years. If patients who have already suffered from lichen planus notice changes in their mouth, they should see a doctor immediately to rule out oral cancer or at least treat it early.
Since it is not possible to say what causes lichen planus, there are no measures that can be used to prevent the disease. However, patients who have previously had lichen planus are advised to avoid skin irritation, practice good oral hygiene, and visit their dentist regularly to minimize the risk of developing lichen planus again.
The disease lichen ruber planus can usually lead to various symptoms and complications, whereby the further course can vary greatly and in many cases depends on the time of diagnosis and the exact severity of the disease. Most of those affected suffer from various skin complaints due to lichen ruber planus. Aftercare focuses on how to deal with the disease well, since the external appearance is usually affected and those affected are ashamed of it. They should avoid excessive exposure to the sun, even if it is still unclear what causes the disease to develop. Regular visits to the treating doctor provide information about the healing process and ensure that further complications will arise.
You can do that yourself
Lichen planus does not always need treatment. The disease often resolves on its own. Nevertheless, symptoms may appear that require medical clarification.
A change in diet often helps with minor symptoms. Physical activity can also strengthen the immune system and thereby help in the healing of lichen planus. A prerequisite for this, however, is good personal hygiene. The affected areas must be cleaned daily, avoiding the use of care products with irritating substances. In the case of severe symptoms, special cortisone ointments from the pharmacy can be used. In many cases, slight skin changes can be reduced with homeopathic remedies such as marigold ointment or a bath with medicinal herbs.
If these measures have no effect, a doctor must be consulted. The condition may have a serious underlying cause that needs to be diagnosed and treated first. If the lichen planus should cause mental problems, a conversation with a therapist is indicated. Those affected should confide in a family member or friend and go to the doctor together with them.
However, the most important self-help measure for lichen planus is to avoid mechanical stimuli. If possible, those affected should not wear irritating clothing and should not scratch the lichen.