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Diseases and Conditions
Lichen planus
From MayoClinic.com
Special to CNN.com

Introduction

Lichen planus is an inflammatory skin condition. It appears as rows of itchy, flat-topped bumps (lesions) on the arms and legs. Sometimes, lichen planus affects the mucous membranes, especially in the mouth and genitals, causing pain, soreness or a burning sensation.

Lichen planus isn't an infectious disease and isn't contagious. But it can be persistent, lasting months or even years. It may reappear after it goes away. This makes treatment of lichen planus difficult. Self-care measures, such as tub soaks and cool compresses, can help. But more bothersome symptoms may need prescription ointments or creams to reduce the itching and inflammation.

Signs and symptoms

Lichen planus is an itchy rash, usually on the insides of the wrists, ankles and forearms. This rash can also appear on the scalp, lower back, neck, nails, and mucous membranes that line the mouth, nose, vagina, penis and anus. Lichen planus may cause scarring when it involves the nails or scalp.

Signs and symptoms of lichen planus include:

  • Rows of flat-topped bumps that may vary in color from purple to pink to red
  • Itching, which may be severe
  • Soreness or a burning sensation when involving the mucous membranes
  • Grooving, splitting, thinning or nail loss when involving the nails
  • Redness, irritation, hair thinning and hair loss when involving the scalp

The initial attack may persist for weeks or months, and recurrences can continue over many years. Once the rash resolves, dark brown or gray spots may linger on the skin. These may be more noticeable in people with darker skin.

Signs and symptoms of oral lichen planus — lichen planus of the mouth — often consist of a dry mouth, a metallic taste or blunted taste sensation, or burning in the mouth. Oral lichen planus may appear before the skin rash and be the only evidence of the disease.

Causes

The exact cause of lichen planus isn't known. In some cases, it appears to be triggered by an allergic or immune reaction to a medication or other substance. And some cases have been linked to infections, such as hepatitis C. But more often, the source can't be determined.

When to seek medical advice

Consult your family doctor or a dermatologist if you suspect you have lichen planus, especially if it involves the mucous membranes of your mouth or genitals. Your doctor can recommend a treatment plan to reduce inflammation and itching, and he or she can monitor any changes in the affected tissues.

Also, be sure to seek medical advice if your signs and symptoms worsen or they don't improve with self-care measures. You may need a stronger medication to manage the problem.

Screening and diagnosis

Your doctor may ask about your symptoms and medical history, examine your skin, and order tests. Your doctor may suggest a skin biopsy to confirm a diagnosis of lichen planus. During a biopsy, the doctor removes a small sample of tissue from the affected area for examination under a microscope.

Complications

Lichen planus of the skin is generally noncancerous (benign). It may clear up with treatment but can persist for months to years. People with long-term lesions of the mucous membranes are at greater risk of squamous cell carcinoma — a form of skin cancer. In these cases, a doctor may advise regular examinations to monitor any changes in the skin. It's also important to stop any tobacco use because tobacco raises your risk of squamous cell carcinoma.

Treatment

Lichen planus on the skin usually clears without treatment within eight to 12 months. Mild symptoms may require only self-care measures and periodic observation by your doctor. More bothersome symptoms may be treated with ointments or creams to reduce inflammation and itching.

Treatment may include:

  • An ointment or cream containing a steroid-sparing immune-modulating medication, such as imiquimod (Aldara) or tacrolimus (Protopic)
  • Antihistamines
  • Phototherapy with ultraviolet light
  • Pills taken by mouth (oral) corticosteroid medications, in severe cases

If you have lichen planus of the mucous membranes, treatment is often challenging and may take years. The most effective treatment for this type of lichen planus is oral corticosteroid medications in addition to high-potency corticosteroids applied to the affected areas.

Self-care

Self-care measures can help reduce the itching and inflammation caused by lichen planus. These include:

  • Tub soaks with colloidal oatmeal (Aveeno, others)
  • Cool compresses
  • Hydrocortisone cream or ointment, containing at least 1 percent hydrocortisone
  • Over-the-counter oral antihistamines, such as diphenhydramine (Benadryl, others), if itching is severe

August 15, 2006

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