Lichen Planus: Meaning, Causes, Symptoms, Treatment

Written by Medicover Team and Medically Reviewed by Dr Divya Manchala , Dermatology

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Lichen planus is a skin problem that can affect the skin, mouth, nails and hair. It happens when the body's immune system attacks its own tissues by mistake. It is not contagious, so you cannot get it from someone else and it usually does not put your life at risk.

But it can cause itching, pain and marks on the skin that may make you uncomfortable or self-conscious. Knowing about the different lichen planus types, symptoms, causes, risk factors and treatments can help you manage it better.

Types of Lichen Planus

Lichen planus can appear in several forms depending on the body part affected. These are commonly referred to as lichen planus types and they vary in symptoms and severity.

Cutaneous (Skin) Lichen Planus: It affects the skin, forming purple, flat-topped, itchy bumps, usually appearing on the wrists, ankles, lower back and legs.

Oral Lichen Planus: Affects the mouth, tongue or gums, appearing as white lacy patches, redness or painful sores. Often chronic, requiring ongoing management.

Lichen Planus Pigmentosus: Causes dark brown to grayish-black patches on sun-exposed areas or body folds. More common in people with darker skin tones.

Genital Lichen Planus: Affects the vulva, vagina, penis or scrotum, causing soreness, pain or erosive ulcers that may impact intimacy.

Scalp (Lichen Planopilaris): Targets hair follicles, leading to inflammation and scarring hair loss (alopecia) over time.

Nail Lichen Planus: Causes thinning, ridging, splitting or even loss of nails, affecting both appearance and nail health.

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What are the symptoms of lichen planus?

The condition presents differently depending on the site of involvement. Recognising lichen planus symptoms early helps in timely care.

Common symptoms include:

• Itchy, flat-topped, purplish bumps on the skin.
• Lesions may appear in clusters or spread over time.
• Fine white lines (Wickham's striae) on the bumps.
• Dark spots may remain after lesions heal.
• White, lace-like patches inside the mouth or on the tongue.
• Painful ulcers or burning while eating spicy or acidic food.
• Pain, redness, sores or scarring in the genital area.
• Hair thinning, patchy bald spots or permanent scalp scarring.
• Nail ridges, thinning, discoloration or nail loss.
• Symptoms can appear suddenly or develop slowly over time.

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Causes of Lichen Planus

While the exact lichen planus causes are unclear, triggers like immune dysfunction, viral infections, genetics, medications, and stress may play a role.

• Immune system dysfunction: The body's immune system mistakenly attacks its own skin, mouth, nails, or hair tissues, causing inflammation and lichen planus symptoms.
• Genetic predisposition: People with a family history of autoimmune disorders have a higher risk of developing lichen planus due to inherited immune system tendencies.
• Infections: Viral infections, especially hepatitis C, can trigger the immune system to react abnormally, leading to the development of lichen planus.
• Medications: Certain drugs used for blood pressure, arthritis, or heart conditions can cause lichenoid reactions that mimic or trigger lichen planus.
• Allergic reactions: Exposure to dental materials, metals, or chemicals may provoke immune reactions that contribute to the development of lichen planus.
• Stress: Emotional or physical stress can worsen lichen planus symptoms by affecting the immune system and triggering flare-ups.

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Risk Factors of Lichen Planus

Anyone can develop lichen planus, but certain factors increase the risk:

• Most common in middle-aged adults (30 & 60 years).
• Women are slightly more affected than men.
• Family history of autoimmune conditions.
• Chronic liver disease or hepatitis C infection.
• Long-term use of medications that can trigger lichenoid reactions.
• High stress levels or a weakened immune system.

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Complications of Lichen Planus

While many cases resolve within a couple of years, some lead to long-term issues. Understanding lichen planus complications helps in early management.

• Persistent itching, pain or burning in affected areas.
• Dark patches may remain after rashes heal.
• Oral involvement can increase the risk of infections or, rarely, oral cancer.
• Genital lesions may cause scarring or discomfort during intercourse.
• Scalp and nails may experience permanent damage.
• Visible lesions can impact mental well-being, causing stress or reduced confidence.

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When to See a Doctor

Seek medical attention if you notice:

• Persistent itchy rashes or purple bumps on the skin.
• White patches, painful sores or burning in the mouth (lichen planus mouth).
• Painful genital sores or discomfort during intimacy.
• Hair loss, nail changes or scarring.
• Difficulty eating, swallowing or speaking due to oral lesions.

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How is lichen planus diagnosed?

Diagnosis of lichen planus starts with examining the skin, mouth, nails, and medical history. Tests like biopsy, blood work, and allergy checks confirm the condition.

• Review medical history and perform a physical exam to identify skin, oral, or nail changes.
• Take a small skin tissue sample (biopsy) to examine under a microscope.
• Conduct blood tests to check for hepatitis C or other underlying conditions.
• Perform allergy tests to rule out triggers causing lichenoid reactions.
• Examine oral and genital areas if mucous membranes show symptoms.
• Accurate diagnosis ensures proper treatment and prevents mismanagement of lichen planus.

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Lichen Planus Treatment & Management

There is no permanent cure, but symptoms can be controlled effectively. Treatment depends on severity, type and affected area.

General Management Approaches

Management focuses on reducing inflammation, relieving symptoms, and preventing flare-ups through medications, light therapy, and lifestyle changes.

• Apply topical corticosteroids to ease itching and inflammation.
• Take oral medications for severe cases.
• Use light therapy (PUVA) for widespread or stubborn lesions.
• Follow lifestyle measures like stress management, good oral care, and avoiding triggers.

Oral Lichen Planus Treatment

Treatment aims to relieve pain, control inflammation, and prevent oral complications.

• Use antiseptic mouthwashes or corticosteroid gels.
• Attend regular dental checkups to monitor oral health.

Lichen Planus Pigmentosus Treatment

Treatment focuses on reducing pigmentation, preventing darkening, and improving the appearance of affected skin.

• Apply sunscreen to protect skin from further darkening.
• Use topical lightening agents or steroid creams to reduce pigmentation.
• Consider laser therapy or chemical peels for resistant or stubborn patches.

Are there natural ways to manage lichen planus symptoms?

Lichen planus can cause itching, discomfort, and irritation. Some home remedies may help relieve symptoms:

• Aloe vera soothes and heals skin
• Oatmeal paste calms irritation
• Cool compresses and moisturizers soothe skin
• Stress management helps prevent flare-ups
• Avoid scratching and harsh soaps to protect skin.

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Conclusion

Lichen planus is a chronic condition that can affect the skin, mouth, nails, scalp, and genitals. Early recognition of symptoms and timely medical care help prevent complications such as scarring, hair loss, or oral issues. With appropriate treatment, regular checkups, and lifestyle support, most people can manage their symptoms effectively and maintain a good quality of life.

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