Lichen Planus

Lichen Planus

Lichen planus is an inflammation of the skin, nails, or mucous membrane (mucosa) due to abnormalities in the body's immune system. Lichen planus is not contagious like an infection, but can be experienced by people of all ages.

Lichen planus that appears on the skin is characterized by scaly skin and a purplish-red rash or patch that generally feels itchy. Meanwhile, in mucosal areas, such as the mouth or vagina, lichen planus is characterized by the appearance of white spots that sometimes feel painful.

As already mentioned, lichen planus is not  a contagious disease . However, this disease can develop into a chronic skin disease and spread to other areas. Lichen planus most often occurs in people aged 30–60 years.

Causes of Lichen Planus

Until now, the cause of lichen planus is still not clearly known. However, this condition is suspected to occur when a person is affected by an autoimmune disorder , which is a condition when the body's immune system mistakenly attacks healthy skin cells or mucous membranes.

In addition, there are several factors known to increase a person's risk of experiencing lichen planus, namely:

  • Have a family history of lichen planus
  • Suffering from allergic contact dermatitis
  • Suffering from an infectious disease, such as hepatitis C
  • Experiencing side effects of certain drugs, such as nonsteroidal anti- inflammatory drugs , antimalarials, blood pressure lowering drugs,  diuretics , or drugs for diabetes
  • Have undergone an organ transplant operation
  • Exposure to metal mercury and gold, for example from dental fillings, jewelry, or chemical fluids used in the photo printing process

Symptoms of Lichen Planus

The symptoms of lichen planus can vary, depending on which part of the body is affected. The following are some of the symptoms of lichen planus that can appear, namely:

  • The skin rash is purplish-red and raised on the skin
  • The skin feels itchy and scaly
  • The mouth is dry and bitter
  • Nails are broken, brittle, and can come off
  • Hair loss
  • White spots in the vagina accompanied by pain and a burning sensation
  • Ring-shaped purplish spots on the tip of the penis that do not feel painful
  • White spots shaped like lines in the mouth ( Wickham striae )

Generally, the rash symptoms that appear on the skin can last for 6-12 months and then disappear on their own. However, in some cases, the rash can last longer on the skin. In addition, the former rash will usually take several months or years to fade completely.

When should you go to the doctor?

Do a self-examination to a doctor if you experience various symptoms of lichen planus, especially if:

  • Symptoms appear for no apparent reason
  • Symptoms last longer than expected
  • Symptoms worsen to cause signs of infection
  • Symptoms did not improve after self-treatment

You are also advised to see a doctor if you experience symptoms of lichen planus in the mouth or vagina. Early examination will help the doctor in providing treatment. That way, complications can be prevented.

Diagnosis of Lichen Planus

To diagnose lichen planus, the doctor will ask questions about the symptoms experienced by the patient, the patient's health history, as well as the medicines and supplements the patient has consumed during this time.

Next, the doctor will perform a physical examination, especially on the skin, mouth, or vagina, which is experiencing symptoms of lichen planus. If necessary, the doctor will also carry out some supporting examinations to confirm the diagnosis of lichen planus, such as:

  • Biopsy , to detect lichen planus through tissue samples taken from problematic skin or mucosa
  • Allergy test, to find out if there is an allergic reaction that may trigger lichen planus
  • Blood tests , to detect other factors that may cause lichen planus, such as hepatitis C

Treatment of Lichen Planus

Treatment of lichen planus aims to relieve symptoms, prevent the appearance of complications, and reduce the risk of recurrence of this disease later in life. The treatment method will be adjusted to the patient's health and the severity of the condition as a whole.

Mild lichen planus usually clears up on its own within a few weeks or months. However, if the patient has severe lichen planus, the doctor will give medicine to help alleviate the symptoms experienced by the patient.

Some of the treatment methods that doctors can do to deal with lichen planus are:

  • Administration  of antihistamines , in the form of oral or topical medications, to reduce itching caused by lichen planus
  • Administration of corticosteroid drugs  , in the form of ointments, tablets, or injections, to reduce inflammation
  • Administration  of immunosuppressant drugs , in the form of creams or ointments, to suppress excessive immune system activity until symptoms subside
  • Treatment with phototherapy or ultraviolet rays, to eliminate lichen planus on the skin

If lichen planus does not improve with drugs and phototherapy, the doctor can give  retinoid ointment . However, it should be known that retinoid ointment can cause the skin to experience irritation, redness, and peeling. Retinoid ointment also risks causing birth defects if consumed by pregnant women.

To deal with lichen planus that is accompanied by complications, the doctor will give antibiotics or antifungal drugs.

In addition to treatment from the doctor, patients are advised to do some of the following to reduce itching that appears due to lichen planus on the skin, namely:

  • Do not scratch the rash.
  • Soak the rash in an oatmeal bath .
  • Use soap and shampoo products that contain mild chemicals to prevent skin irritation.
  • Apply a cold compress on the itchy and reddened skin.
  • Apply a moisturizing cream to prevent dry skin.

In patients with lichen planus in the mouth who use dentures made of gold or amalgam, consult a dentist about whether it is necessary to replace the dentures.

Some other things that can be done to ease the symptoms are:

  • Brush your teeth regularly, at least 2 times a day
  • Avoid foods that are too spicy or acidic
  • Avoid mouthwash products that contain alcohol
  • Stop smoking and consuming alcoholic beverages

Meanwhile, in patients with lichen planus in the genital area, efforts that can be made to ease the symptoms are by not wearing tight clothes or pants. If the rash is itchy and swollen, soak the genital area in cold water to relieve symptoms.

Complications of Lichen Planus

Untreated lichen planus can cause various complications according to the location of the disease. The complications include:

  • Severe pain and abrasions in the vulva and vagina that risk causing sexual dysfunction
  • Post-inflammatory hyperpigmentation
  • Increased risk of skin cancer type  squamous cell carcinoma
  • Increased risk of oral cancer
  • Difficulty eating due to mouth sores

Prevention of Lichen Planus

Until now, it is not known exactly how to prevent lichen planus. However, there are efforts that can be made to avoid the risk factors of lichen planus, among others:

  • Stop smoking and consuming alcoholic beverages
  • Avoid foods that are too salty, sour, or spicy
  • Brush your teeth twice a day and avoid using mouthwashes that contain alcohol
  • Check your teeth regularly at the dentist
  • Undergo routine health check-ups if you suffer from a disease that can increase the risk of lichen planus, such as hepatitis C or an autoimmune disease
  • Consult with a doctor before consuming medicines or supplements
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