Lichen planus is a non-infectious, itchy rash that can affect many areas of the body.
Affected areas can include:
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.
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.
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 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.
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 symptoms of lichen planus of the skin are:
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.
The symptoms of lichen planus of the mouth are:
Mild cases of oral lichen planus do not usually cause any pain or discomfort.
The symptoms of lichen planus of the penis are:
The symptoms of lichen planus of the vulva and vagina include:
Sometimes, other areas can also be affected by lichen planus. These include:
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.
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.
An allergic reaction to certain medications is another possible cause of lichen planus. For example:
Lichen planus is often diagnosed by a doctor or dentist examining the affected area.
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.
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.
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.
Below is some general self-help advice that you can follow to help ease your symptoms and prevent them from getting worse.
There are a number of medications and treatments that may be recommended for lichen planus of the skin, hair and nails.
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:
Potential side effects of topical corticosteroids can include:
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 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:
Read more about the side effects of corticosteroids.
Other treatments that may be recommended for lichen planus of the skin are described below.
Mild cases of lichen planus of the mouth will not need any treatment. However, in more severe cases, treatment includes:
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:
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."
Complications of lichen planus may include discoloured skin and, in some cases, erosive lichen planus may develop into certain types of cancer.
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 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.
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."
Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.