Lichen planus is a common chronic inflammatory disease that causes swelling and discomfort on the skin or inside the mouth. The skin affected by this autoimmune disease develops pimple-like bumps, usually accompanied by itching. Lichen planus inside the mouth can also cause pain or a burning sensation. In addition to the skin and inside the mouth, this disease can affect the nails, hair, mucous membranes, the back of the hands, the inside of the forearms, the body, and the front part of the lower legs. Read this article to learn more about lichen planus, its symptoms, causes, diagnosis, and treatment.
Lichen Planus Histology
Lichen planus is characterized histologically by specific changes in the skin and mucous membranes. The hallmark feature is a band-like infiltration of lymphocytes in the superficial dermis that targets the dermo-epidermal junction.
This inflammatory response leads to basal cell degeneration, where the basal keratinocytes appear damaged or vacuolated. These damaged keratinocytes often form colloid bodies (Civatte bodies), which are eosinophilic and represent apoptotic keratinocytes.
Lichen Planus Histology
The epidermis may show hypergranulosis, with an increase in the granular layer and irregular acanthosis, resulting in a saw-tooth appearance of the rete ridges.
Another common feature is hyperkeratosis, a thickening of the stratum corneum, often without parakeratosis. In the oral mucosa, a similar pattern is observed with a thickened epithelium but without the stratum corneum.
In addition, there may be subepithelial clefts (Max-Joseph spaces) in severe cases. The inflammatory process and epithelial changes collectively disrupt the normal structure of the skin or mucosa, leading to the characteristic lesions and symptoms of lichen planus.
Lichen Planus Pathology
Lichen planus is an autoimmune disease, meaning the body’s immune system mistakenly attacks its own skin and mucous membranes. This happens because the immune cells, called T-cells, target and damage the skin cells (keratinocytes) in the outer layer of the skin.
As a result, the affected skin becomes inflamed, and the damaged cells form small clumps known as colloid bodies. These clumps are signs of the skin cells dying. The immune cells gather in the skin, causing redness, swelling, and thickening of the skin.
This process can lead to scarring and cause the skin to look rough or bumpy. Lichen planus can also affect the inside of the mouth, causing white patches or sores, which can be painful.
In severe cases, it may even cause long-term damage to the skin or mucous membranes. The condition can last for a long time and may come and go, depending on the activity of the immune system.
Is Lichen Planus Cancer?
Cancer is a dangerous disease, and its name often causes fear. As a result, some people may worry that lichen planus is a form of cancer.
In fact, cancer develops when cells grow uncontrollably, whereas lichen planus is an autoimmune disease caused by the body’s immune system mistakenly attacking its own cells.
Instead of fighting off harmful foreign agents, the immune system targets the body’s own tissues, leading to cell destruction.
Is Lichen Planus Cancer?
It is important to understand the characteristics of lichen planus, which include the following:
- Lichen planus is not contagious and does not spread from person to person.
- It is a hereditary disease, meaning it can be passed from parents to children.
- Lichen planus is not caused by an infection.
- It is not a life-threatening condition and typically improves on its own.
- The disease may return after some time.
Lichen Planus Symptoms
The signs and symptoms of this disease vary depending on the affected area. For example, if one nail is affected, it can affect other nails as well. Some of the most common symptoms of this disease are:
- Flat, purple, shiny bumps on the inner forearm, wrist, or ankle
- Red lines in areas of the skin that have been scratched
- Black lines running from top to bottom of the nail
- White bumps on the tongue or inside the cheeks
- Painful sores in the genital area or mouth
- Scarring and nail damage or nail loss
- Hair loss
- Itching
Lichen Planus Causes
Lichen planus is an autoimmune disorder mediated by T lymphocytes, in which inflammatory cells attack an unknown protein in the skin and mucosal keratinocytes. Factors that may contribute to the development of lichen planus include:
- Genetic predisposition
- Physical and mental stress
- Skin injury, lichen planus often appears in areas where the skin has been scratched or after surgery (Koebner phenomenon)
- Local skin diseases such as shingles
- Systemic viral infections, like hepatitis C, may alter the self-antigens on the surface of basal keratinocytes.
- Contact allergies, such as dental fillings containing certain metals in oral lichen planus (rare), and people working in the color photographic printing industry
- Medications, gold, quinine, and quinidine can cause lichen-like rashes
- A deficiency in vitamin D may be linked to oral lichen planus. Its relationship with other types of LP remains unknown.
Lichen Planus Causes
Lichen Planus Treatment
Doctors use different methods to treat this disease, depending on the severity and type of condition. The aim of treating lichen planus is to control symptoms and prevent the progression of the disease. Based on the patient’s condition, the doctor will choose an appropriate treatment plan. The common methods of treating this disease are:
- Topical treatment with corticosteroid creams and antihistamines
- Oral corticosteroids for severe cases and the use of immunosuppressive drugs like methotrexate, cyclosporine, or azathioprine
- Phototherapy using ultraviolet UVB light
- Herbal treatments such as quercetin or henna
- Food supplements such as antioxidants
- Pharmacological Treatment of Lichen Planus
For the pharmacological treatment of this disease, doctors use a variety of topical and oral medications. Some of the common drugs used to treat this disease include:
- Medium to strong corticosteroid creams to control inflammation and itching, such as betamethasone, fluticasone, or clobetasol
- Antihistamine creams like diphenhydramine to reduce itching
- Creams containing anti-cancer compounds such as tacrolimus or pimecrolimus for resistant cases
- Oral prednisone for severe or widespread cases
- Methotrexate, cyclosporine, or azathioprine
- Antihistamines like cetirizine to control itching
- Herbal treatments and supplements such as quercetin, henna, and antioxidants
Lichen Planus & Metronidazole
Lichen planus is a chronic inflammatory skin and mucosal disease that can be challenging to treat. Metronidazole, an antibacterial and antifungal drug, is sometimes considered as part of the treatment for lichen planus. However, metronidazole alone is not effective in treating this disease. It can be used as an adjunctive therapy alongside the main drugs, such as corticosteroids.
In cases of oral lichen planus, metronidazole may help reduce inflammation and heal mouth ulcers. It can also be useful in controlling genital infections.
Home Remedies for Lichen Planus
In some cases, home remedies can help control the symptoms of this disease:
- Use of mild corticosteroid ointments like hydrocortisone or betamethasone
- Natural moisturizers like aloe vera, coconut oil, or olive oil
- Avoiding irritants such as harsh soaps, alcohol, cigarettes, and acidic foods
- Antiseptic ointments containing chlorhexidine gluconate
- Anti-itch ointments containing ingredients like camphor, menthol, or cooling compounds
Lichen Planus Treatments
Types of Lichen Planus
This disease can affect different parts of the body and has different types, including:
1. Lichen Planus Oral
This type affects the mucous membranes of the mouth, appearing as white bumps or patches or lace-like streaks on the mucous lining of the gums, tongue, lips, and even the cheeks. Oral sores are usually not painful but may be itchy and can cause redness, swelling of the gums, and dryness in the mouth.
Eating spicy or acidic foods may worsen oral symptoms, and the patient might have difficulty tasting food and sometimes experience a metallic taste in the mouth.
2. Lichen Planus Vulvar
Lichen planus vulvar affects the skin and mucous membranes of the vulva in women. It causes itching, burning, and pain in the genital area, often leading to the appearance of white, lacy patches or red, inflamed areas.
In severe cases, it can cause scarring and narrowing of the vaginal opening, which may interfere with sexual activity. Women with lichen planus vulvar may also experience pain or discomfort during urination.
3. Nail Lichen Planus
This type causes the immune system to mistakenly attack the cells of the nails. Nail lichen planus leads to color changes and deformities in the nails, the appearance of black lines on the nails, or even nail loss. When nail cells are attacked by the immune system, the nails’ appearance and color change, and in some cases, nails may fall off.
4. Lichen Planus Scalp
Lichen planus of the scalp affects the hair follicles and leads to hair loss, thinning, and in some cases, scarring of the scalp. This type can cause patchy hair loss and inflammation, making the scalp itchy and sore.
It may lead to permanent hair loss if scarring occurs, as the follicles are damaged beyond repair. People with lichen planus scalp may also experience scalp scaling or flaking.
Types of Lichen Planus
Final Word
Lichen planus is a common skin inflammation that affects the mouth and nails and causes redness, itching, and a burning sensation in the skin, mucous areas, and genital area. Although it is not dangerous or contagious and usually resolves on its own, the exact cause of this autoimmune disease is unknown. By taking care of your skin and managing stress, you can reduce your risk of developing this skin disease. In case of severe symptoms, it is necessary to see a doctor immediately. There is no cure for this disease, and the focus is on preventing further progression and maintaining the quality of life with the help of doctor’s advice. For this reason, it is very important to visit and follow up regularly with a dermatologist in the management of lichen planus.
