Lichen planus

Lichen planus is a non-infectious, itchy rash that can affect many areas of the body.

Information written and reviewed by Certified Doctors.

Contents

Introduction

Lichen planus is a non-infectious, itchy rash that can affect many areas of the body.

Affected areas can include:

  • the arms and legs
  • the mouth (oral lichen planus)
  • the nails and scalp
  • the vulva, vagina and penis

Read more about the symptoms of lichen planus.

The exact cause of lichen planus is unknown. However, the condition is not infectious and does not run in families. It cannot be passed on to other people, including sexual partners. Read more about the causes of lichen planus.

A doctor can usually diagnose lichen planus by examining the rash and asking you about your symptoms. Oral lichen planus is often diagnosed by a dentist during routine dental check-ups. Read more about diagnosing lichen planus.

Treating lichen planus

There is no single treatment that can cure lichen planus completely. However, treatments are available to help manage the symptoms and make living with it easier. For example, steroid creams are often used to help relieve the itch and control the rash.

Most cases of lichen planus of the skin clear up on their own within six to nine months. The rash rarely lasts longer than 18 months.

Learn more in how lichen planus is treated.

Who is affected

It is estimated that lichen planus affects 1-2% of the population worldwide and is more common in adults over the age of 40.

Lichen planus of the skin affects men and woman equally. However, oral lichen planus is more common among females. The mouth is affected in around 50% of all cases of lichen planus (oral lichen planus).

Erosive lichen planus

Erosive lichen planus is a rare form of the condition that can last for a long time. It causes painful ulcers to develop in the mouth and in male and female genital areas.

In some cases, long-term erosive lichen planus can increase the chance of some types of cancer developing.

Read about complications of lichen planus for more information about erosive lichen planus.

Symptoms

The symptoms of lichen planus vary depending on which area of the body is affected.

The areas of the body that can be affected by the condition include:

  • the skin
  • the mouth
  • the penis
  • the vulva (external female sex organs) and vagina

Lichen planus of the skin

The symptoms of lichen planus of the skin are:

  • purple-red coloured bumps (papules) that are slightly raised, shiny and have a flat top
  • the papules usually measure 3-5mm in diameter
  • the papules may also have irregular white streaks (Wickham's striae)
  • thicker scaly patches can appear, usually around the ankles – this is known as hypertrophic lichen planus
  • itchy skin

Lichen planus of the skin often affects the wrists, ankles and lower back, although other parts of the body can also be affected.

Thickened (hypertrophic) lichen planus affects the shins and ring-shaped lichen planus affects creases in the skin, such as the armpits. After the lesions have cleared, the affected area of skin can sometimes become discoloured.

Lichen planus of the mouth (oral lichen planus)

The symptoms of lichen planus of the mouth are:

  • a white pattern on the tongue and inner cheeks
  • white and red patches in the mouth
  • burning and discomfort in the mouth while eating or drinking
  • painful, red gums
  • recurring mouth ulcers

Mild cases of oral lichen planus do not usually cause any pain or discomfort.

Lichen planus of the penis

The symptoms of lichen planus of the penis are:

  • purple or white ring-shaped patches on the tip of the penis (glans)
  • bumps (papules) that are flat-topped and shiny
  • the rash is often not itchy

Lichen planus of the vulva and vagina

The symptoms of lichen planus of the vulva and vagina include:

  • soreness, burning and rawness around the vulva
  • the vulva may be covered in white streaks and be a red, pink or pale white colour
  • if the vagina is affected, sexual intercourse can be painful
  • if the outer layers of skin break down, moist, red patches can form
  • scar tissue can form, which distorts the shape of the vagina
  • a sticky, yellow or green discharge, which may be bloodstained
  • the opening of the vagina can become narrowed

Other areas

Sometimes, other areas can also be affected by lichen planus. These include:

  • the nails – these can become thinner, ridged and grooved, or they may become darker, thicker or raised, and may sometimes shed or stop growing
  • the scalp – red patches can appear around clusters of hair and in some cases, permanent hair loss can occur

Causes

The cause of lichen planus is unknown. However, it is thought to be related to either the immune system (the body's natural defence against infection and illness) or an allergic reaction to certain medicines.

Lichen planus is not infectious, does not usually run in families and cannot be passed on to others.

Autoimmune reaction

The immune system protects your body against infection by producing antibodies (proteins) that attack bacteria and viruses.

In people with lichen planus, it is thought that the immune system becomes overactive, causing an excess amount of proteins to be produced which then inflames the skin. This is known as an autoimmune reaction and causes the symptoms associated with the condition.

Reaction to medication

An allergic reaction to certain medications is another possible cause of lichen planus. For example:

  • gold injections – these are disease-modifying anti-rheumatic drugs (DMARDs) which are sometimes injected into the muscles of people with arthritis to help reduce swelling (inflammation) and painful joints
  • antimalarial tablets – these help to treat and prevent malaria (a tropical disease spread by infected mosquitoes)

Diagnosis

Lichen planus is often diagnosed by a doctor or dentist examining the affected area.

Lichen planus of the skin

Your doctor may be able to make a diagnosis based on the characteristic rash. However, lichen planus can be mistaken for other skin conditions such as eczema, which also causes the skin to become red, flaky and itchy.

If your doctor is unable to make a confident diagnosis by examining your skin, they may want to take a small sample (biopsy) of skin to examine under a microscope.

If a skin biopsy is required, you will be given a local anaesthetic to numb the affected area so you do not feel any pain or discomfort during the procedure.

Lichen planus of the mouth (oral lichen planus)

Oral lichen planus can be diagnosed by a dentist or a doctor looking at the inside of your mouth.

As with lichen planus of the skin, a biopsy may be recommended to confirm the diagnosis. A sample of mouth tissue will be removed to examine under a microscope. You will be given a local anaesthetic to numb the pain.

Treatment

There is no cure for lichen planus, so treatments aim to ease the symptoms and clear the rash. Mild cases of lichen planus will not require treatment.

Self-help

Below is some general self-help advice that you can follow to help ease your symptoms and prevent them from getting worse.

Lichen planus of the skin

  • avoid washing with soap or bubble bath – use plain warm water instead
  • wash your hair over a basin to stop affected areas of skin coming into contact with shampoo
  • use an emollient to moisturise your skin

Lichen planus of the mouth (oral lichen planus)

  • avoid eating spicy foods and anything acidic, such as fruit juice, as they can irritate oral lichen planus
  • avoid eating sharp food, such as crusty bread
  • avoid drinking alcohol, particularly spirits
  • if areas of your mouth are painful, stick to soft, bland foods, such as mashed potatoes and porridge
  • if possible, continue to use your usual toothpaste
  • avoid using mouthwashes that contain alcohol as they may be too strong, and keep your mouth as clean as possible
  • visit your dentist regularly to help keep your gums and teeth healthy

Lichen planus of the genitals

  • avoid washing with soap or bubble bath – use plain warm water or a soap substitute instead, such as aqueous cream
  • use an emollient, such as petroleum jelly, before and after urinating
  • applying ice packs to the affected areas may soothe itching and swelling (never apply an ice pack directly to your skin – wrap it in a clean tea towel before placing it on your body)
  • women should avoid wearing tights

Lichen planus of the skin, hair and nails

There are a number of medications and treatments that may be recommended for lichen planus of the skin, hair and nails.

Corticosteroid creams and ointments

Creams and ointments that contain corticosteroids (artificial hormones) are often used to treat inflammatory skin conditions. These are often described as topical corticosteroids.

Topical corticosteroids help treat the swelling (inflammation) and redness caused by lichen planus. Strong topical corticosteroids, such as clobetasol propionate, are also effective in reducing any itchiness that you may have.

Treatment is applied to the red or purple itchy spots, but should be stopped when the colour of the rash changes to brown or grey. This pigment change happens when the inflammation has settled. Continuing to apply the corticosteroid cream to the brown areas of skin will gradually cause the skin to thin.

The side effects of corticosteroids can vary depending on:

  • the type and severity of treatment being used
  • the amount of time the treatment is used for
  • the nature of the condition being treated

Potential side effects of topical corticosteroids can include:

  • redness of the skin
  • burning and stinging on the skin
  • skin rash
  • thinning of the skin (atrophy)
  • stretch marks (striae)
  • contact dermatitis, a condition that causes skin inflammation
  • perioral dermatitis, a condition that causes red lumps to develop on the face
  • acne, a skin condition that causes spots to develop on the face
  • excessive hair growth (hypertrichosis)
  • lightening of the skin

You should always check the patient information leaflet that comes with your medicine to ensure that you use the correct dosage, and take note of any cautions and potential side effects.

Read about topical corticosteroids (steroid creams) for more information about this type of treatment.

Corticosteroid tablets

Corticosteroid tablets are sometimes used to treat severe cases of lichen planus, when the symptoms are not being effectively controlled with creams or ointments.

Possible side effects of corticosteroid tablets used on a short-term basis can include:

  • an increase in appetite
  • weight gain
  • insomnia (inability to sleep)
  • fluid retention (inability to pass urine)
  • mood changes, such as feeling irritable or anxious

Read more about the side effects of corticosteroids.

Other treatments

Other treatments that may be recommended for lichen planus of the skin are described below.

  • antihistamines – this type of medication is often used to treat symptoms of allergies, such as itchy skin. If you have lichen planus of the skin that is causing itchiness, antihistamines may be prescribed to help reduce this.
  • light treatment – there are two types of light treatment: ultraviolet B (UVB) and psoralen plus ultraviolet A (PUVA). UVB is the most commonly used light treatment, but PUVA may be recommended in severe or widespread cases of lichen planus that do not respond to other types of treatment. PUVA can cause side effects that your skin specialist (dermatologist) can discuss with you.
  • acitretin – this medication is only prescribed by a specialist and is used to treat severe cases of lichen planus. The tablets have some associated side effects and may not mix well with other medicines. Your doctor can advise you about this.

Lichen planus of the mouth (oral lichen planus)

Mild cases of lichen planus of the mouth will not need any treatment. However, in more severe cases, treatment includes:

  • a mouthwash that contains an anaesthetic to temporarily numb the mouth and make eating easier
  • corticosteroid sprays, mouthwashes, pastes and dissolvable lozenges
  • a mouthwash or gel that contains an antiseptic to help prevent the build-up of plaque in your mouth
  • corticosteroid tablets may be used on a short-term basis in more severe cases of oral lichen planus

Other treatments

If corticosteroids are not effective in treating your symptoms, you may be prescribed a medication that works by suppressing your immune system to try to limit the autoimmune reaction that is thought to cause lichen planus.

These types of treatments are known as immunomodulating agents. Depending on which area of your body is affected by lichen planus, treatments that may be recommended for you could include:

  • topical immunomodulating agents (used to treat lichen planus of the skin) – treatments such as tacrolimus ointment and pimecrolimus cream are rubbed directly onto the skin
  • immunomodulating agents (used to treat lichen planus of the mouth) – these are usually available in the form of tablets or capsules and can be used to treat severe cases of oral lichen planus

Complications

Complications of lichen planus may include discoloured skin and, in some cases, erosive lichen planus may develop into certain types of cancer.

Skin pigmentation

After the lichen planus rash has cleared up, a change in skin colour may occur (a brown or grey mark), which can sometimes last for months. This is known as post-inflammatory hyperpigmentation, and tends to be more noticeable in people with darker skin.

Erosive lichen planus

Erosive lichen planus is a long-lasting (chronic) form of lichen planus that causes painful ulcers to develop, and burning and discomfort in the male and female genital areas.

Occasionally, in around 2% of cases, long-term cases of erosive lichen planus can develop into certain types of cancer, for example:

Regularly examining yourself and being aware of any changes that occur will help you to identify any problems at an early stage. Pay close attention to ulcerated areas in your mouth or genitals that do not heal and persist for a long time. Visit your doctor immediately if you notice any changes that you are concerned about.

You should also visit your dentist regularly to ensure that your teeth and gums remain healthy, and that any ulcers or patches that form in your mouth are examined and treated promptly. Depending on individual circumstances, dental check-ups for adults are recommended between every three and 24 months.

Read more information about how lichen planus is treated, including self-help tips for managing all types of lichen planus.

Bridget's story

At 42, Bridget was diagnosed with a painful, erosive form of lichen planus that affected her vulva and mouth. Today she is relatively pain-free and keeps her condition under control with steroid treatments. Here's her stor

"My problems started with an initial flare-up of vulval pain on Christmas Eve 2003, when I was 42, although looking back I'd had mouth soreness and ulceration for about a year before this.

"I thought I had an infection and went to see my doctor, who treated me for thrush, but the problem remained. I then had an MRI scan, swabs, a gynaecological scan and X-rays of my lumbar area (spine), but none of the tests showed anything abnormal and the doctors didn't know what was wrong.

"I began to give up hope and got very depressed. Every time I went to see my doctor, my flare-up had flared down and there was nothing much to see. In the end I took photographs of my vulva when it had flared up and showed these to my doctor. I got a referral to a dermatologist, and finally I was diagnosed with vulval and oral erosive lichen planus.

"I started treatment at the end of July 2005 with a high potency topical steroid (ointment) for my vulva and a steroid spray for my mouth. It took about four months before my lichen planus was under control with the treatment.

"In the meantime, I was in so much pain I wasn't able to go on long car journeys and had to give up my office-based job, which involved a lot of sitting at a computer. I felt too embarrassed to tell anyone about my condition and a complete failure for not being strong enough to hold down a job.

"I couldn't wear trousers or tights and sometimes even knickers were too painful against my skin. I mainly wear skirts and stockings now. I also can't take baths, only showers, and without any perfumed shower gels.

"After a while I got to know what triggered my flare-ups: stress and sitting for any length of time. I learnt to avoid these as much as possible, although sometimes I flare up for no reason at all.

"My partner and I had a difficult time together, but he stayed with me and we have adapted with the condition. We're now happier than ever.

"Now my condition is managed really well with a steroid cream called Dermovate, which is for the vulva, and an oral steroid for the mouth lesions. I am mainly free from flare-ups and pain.

"In November 2007, I set up the charity UK Lichen Planus in order to provide clear, up-to-date information for other people with the disease and give them some much-needed support."

Dale's story

Dale was diagnosed with oral lichen planus when she was 44, and has learnt to adapt her lifestyle in order to cope. She tells her story.

"I remember waking up one morning in May 1995, when I was 44, and my mouth felt scalded, like I'd eaten something that had burned it. When I went into the bathroom to have a look in the mirror, I was horrified by what I saw. The inside of my mouth was bright red, including my gums and tongue.

"I immediately booked an appointment with my doctor. I was in agony. I could hardly eat or drink anything. Cleaning my teeth was incredibly painful.

"After seeing both my doctor and dentist I was eventually referred to an oral consultant and maxillofacial surgeon, as neither knew what was wrong with me.

"My consultant was brilliant. As soon as I opened my mouth he told me he thought it was oral lichen planus. He made me up lots of lidocaine mouthwash, which acts as an anaesthetic, so I could eat and clean my teeth without pain.

"I had a biopsy and the results confirmed I did have lichen planus. My consultant gave me some oral steroids to take for 10 days. These took away some of the discomfort by reducing the soreness and swelling, but they're not a cure.

"After this treatment I was given a steroid spray to use four times a day. No one really knows what causes lichen planus, but both my consultants were positive that stress aggravates it. It's true that when I'm stressed, I have a particularly horrendous time with my mouth.

"I reached a point where I decided to stop taking steroids for my lichen planus. I didn't want to keep taking them when they weren't making a huge difference. The inside of my mouth is covered in white streaks and patches that are sore all the time, but I try not to think about it and have learned to live with the condition.

"There are certain foods I haven't been able to eat since I was diagnosed. Anything crunchy or crispy will cut my mouth and give me lesions, and citrus foods will bring me up in blood blisters. Spicy foods and mint leave me in agony, but I just work round it and eat other things instead.

"I just get on with life. I try to chill out and keep my stress levels down by going for massages and doing yoga. After all, there are people out there with worse things."

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