Lichen planus causes a characteristic rash that can occur alone or as a feature of other autoimmune disorders and syndromes.
Lichen planus is an autoimmune dermatological condition that can occur as a primary condition or as an accompanying feature in other autoimmune conditions. It is also reported to occur in hepatitis B and hepatitis C infections. Overall, lichen planus is seen in about 0.5 percent of the population. It affects people of all ages, but men tend to be affected at a younger age than women.
Lichen planus is associated with the following autoimmune conditions: alopecia areata,vitiligo, dermatitis herpetiformis, pemphigus, scleroderma, primary biliary cirrhosis,autoimmune hepatitis, ulcerative colitis, thyroiditis, systemic lupus erythematosus (SLE), diabetes mellitus, and pernicious anemia. Lichen planus also frequently occurs with systemic lupus erythematosus as an overlap syndrome. Cases of lichen planus/lupus erythematosus overlap syndrome have also been reported to occur in association with a scarring form of alopecia.
Lichen planus is also reported to occur as part of Multiple Autoimmune Syndrome associated with Reynolds-syndrome. Reynolds syndrome is characterized by acral scleroderma, primary biliary cirrhosis, and Sjogren’s syndrome. In Multiple Autoimmune Syndrome, Reynold’s syndrome is associated with lupus erythematosus/lichen planus overlap syndrome.
The specific cause of lichen planus is not known, but it may be a hypersensitivity reaction by the immune system to a variety of drugs (especially gold salts, bismuth, arsenic, quinine, quinidine, and quinacrine) and various chemicals (including certain chemicals used to develop color photographs), and infectious organisms.
Symptoms
Lichen planus causes small lesions, which may be ulcerative or erosive, that are violet or purple, with multiple angles occurring as flat-topped papules or small plaques. Usually, these lesions are extremely itchy although in some cases they don’t itch. Scratched lesions, which are commonly seen in eczema, are rarely seen in lichen planus. However, the surface of lesions typically has a white lace-like pattern known as Whickham’s striae, which is enhanced when mineral oil is applied to the surface of the lesion.
The lesions in lichen planus tend to cluster together and frequently overlap. Lesions are most often seen on the wrists, forearms, shins, heels, and ankles. New lesions continue to appear for a few weeks to several months. Untreated, the eruptions of lichen planus usually persists for about 12-18 months. In palmoplantar lichen planus, the palms of the hands and soles of the feet are primarily affected.
Lichen planus is one of several disorders that exhibit the Koebner reaction. In this reaction, new lesions develop at the sites of minor injuries, such as scratches or burns within a week of the injury, suggesting the development of lesions is an abnormal manifestation of the normal inflammatory response.
Older lesions, which are starting to heal, and sometimes new lesions as well, may occasionally develop a muddy-brown pigmentation, which may be intense in skin creases.
In about 75 percent of cases, patients with lichen planus develop oral lesions with a white lace-like pattern.
Diagnosis
Lichen planus must be differentiated from eczema, psoriasis, the discoid rash of lupus, and granuloma annulare. When lesions occur in unusual locations on the body, diagnosis may be difficult. The lesions in lichen planus, however, are typically small and have a narrow border compared to granuloma annulare or the lesions that accompany infections. The presence of other autoimmune disorders in patients with characteristic purple skin lesions suggests a diagnosis of lichen planus.
Treatment
Treatment for lichen planus includes immunosuppressive agents such as acitretin prednisone and ultraviolet A-1 phototherapy.
Resources:
Gary White and Neil Cox, Lichen Planus and Lichenoid Disorders in Diseases of the Skin, Merck Medicus, 1999.
F Muller, W Groth, and G Mahrle, Multiple Autoimmune Syndrome. Reynolds-syndrome (acral scleroderma, primary biliary cirrhosis, Sjogren's syndrome) associated with the lupus erythematosus/lichen planus overlap syndrome. Hautarzt, May 2004: 465-470.
The copyright of the article Lichen Planus in Autoimmune Skin Disorders is owned by Elaine Moore. Permission to republish Lichen Planus in print or online must be granted by the author in writing.
I have had this skin disease for 12 years and have been treated with topsyn
gel which is a tempory relief only. Pat
Aug 27, 2008 11:02 AM
Guest
:
I was recently diagnosed with this disease and it is quite severe. I have
been seeing a homepathic doctor and it has helped alot. I am on my third
month and it is clearing rapidly. Jodi
Sep 2, 2008 3:39 PM
Guest
:
I have just started UVB Therapy with my Derm. I appear to have Koebner's
Phenomenon associated with trauma to my skin. This is how I was first
diagnosed with Lichen Planus about 12 months ago. One biopsy came back as
"Comparable to Lichen Planus", the area of traum did not. I'm
finding it very difficult to find a doctor knowlegeable on this subject. I
would really like to be tested for the other associated disorders as listed
above, if tests exist. I was on strong antibiotics 1.5 years ago for
intraabdominal infection... One really hurt. Would really like to know if
there is a connection.
Sep 3, 2008 7:08 AM
Guest
:
Is anyone aware of an association or forum for people diagnosed with Lichen
Planus?
Sep 3, 2008 7:23 PM
Elaine Moore :
Hi, Here's a link to an article mentioning that antibiotics can
trigger lichen planus: www.yourhealthconnection.com/topic/adam1000867 In this article from
Family Physician, the author mentions Koebner's phenomenon being associated
with lichen planus: http://www.aafp.org/afp/20000601/3319.html I've
also heard of Topsyn being good for symptom relief. Best, Elaine
Sep 25, 2008 9:33 PM
Guest
:
I developed this skin disorder in March 08. It took a while to diagnose,
finally establishing it was Lichen Planus through a biopsy. By the time it
was diagnosed it was pretty much all over my body and I was feeling awful
and very scared. After seeing a dermatologist and applying topical steroid
cream for two months without success I went to a Chinese Herbalist and had
great results drinking a formula twice a day she made up for me. It took a
while for the itching to stop completely but it reduced immediately. After
two months the spots stopped appearing and now, three months on the old
spots are hardly visible. I also take a dead sea salt bath or himalayan
salt bath each evening and have been on a liver cleansing diet. I threw
away my shampoos and body lotions and soap and only use very natural
products. I threw away all that awful polyester and now only wear cotton,
hemp & natural fibres. I recommend the Chinese herbs strongly - not
only has the Lichen Planus disappared but I feel better than I have in
years as my doctor is systematically treating each part of my body to
achieve good health. I am also relieved to be out of the western medical
system which I found cold, uncaring and seemingly uninformed about this
horrible skin condition, and so happy to have found a natural answer and a
doctor who truly cares about the health and happiness of her patients.
Jacqueline
Oct 7, 2008 10:09 PM
Guest
:
I was diagnosed by a dentist as having oral lichen planus 6 months ago. I
had it on the inside left cheek area.Since that time, it has spread. I have
it on both sides of my cheeks now. I now have the feeling of something
stuck in my throat. I have been referred to an ENT specialist to have it
checked out. I've had long, strong fingernail most of my life. A few months
before the oral lichen planus, I had ridges show up on 3 fingernails. My
nails were peeling on each side of the ridges and still are. I am
also having issues vaginally...since I am going through menopause... in the
beginning I thought nothing of it. In the past few months it has become
very painful. The gynecologist is suspecting lichen as well. I am going to
have a biopsy done to clarify the problem. Over the past few months, I
have had a few small skin patches show up and a few small papules on my
wrists. Now I have new patches on my forearms. I just had 2 rounds of
antibiotics in the past month for a bladder infection. My mouth became very
inflammed ... I could hardly eat it was so painful and burning. About 24
hours after I finished the antibiotics, my mouth calmed down a bit. I'm trying to remain calm... but I am so frustrated and fearful that I'll
wake up one morning covered in lichen planus! I've always been a healthy
woman, now I am continually getting sick. I seem to catch every bug that
comes around. I'm thinking about going to a homepathic doctor... I need
some relief soon. Debbie
Oct 10, 2008 11:32 AM
Guest
:
Maybe antibiotics are a link. I was on a antibiotic a few months ago and
about the same time that I had finished taking them is when I began to see
lessions popping up on and around my shin and ankles. I have given up on
Doctors treating me. I've suffered with LP since I was 18 off and on. I am
50 now. I do notice that when I am under a tremendous amount of stress it
returns. What I do is a regemin of Probiotics. I do believe that LP is
connected with the immune system. Antibiotics distroy the good and bad
germs. We need good germs to keep us healthy. Taking antibiotics breaks
down the immune system and if ones immune system is already compromised it
can lead to any number of allegies and reactions. Luckily for me that my
skin heals very quickly. I'm african american with olive undertones and
the oils in my skin help the healing. But unfortunitly LP leaves scaring
that does take time to go away. I fine Shea Butter works wonders and it is
inexpensive. Also vasoline but can be messy. Best advice I think is to
not overreact and stress out.
Oct 16, 2008 9:10 PM
Guest
:
Have had this diseases for about 6 mos. but mostly only on the inside of my
mouth. I have a few tiny other spots but that's about it so far. The
spots inside my mouth are the corrosive kind from what I can tell. My
dentist gave me Fluocinonide ointment which was the only thing that really
helped clear it up but I have to keep using. My regular doc tried a round
of strong steroids, but it did nothing but make me feel bad. I have
done a lot of reading on the web and found one thing that shows signs of
promise. I have been using sulphur pellets (30c). Ordered them on the
internet. I found a site that said to take 200c (which I took 7 of the 30c
pellets) once a week for three weeks. You put them under your tongue and
let them dissolve. They are very tiny and taste quite good. I think you
can get these at a health food market. I bought mine over the internet
through the mail. I am not telling you this will do anything for you, I am
just tell you what I have been trying. Sulphur could make you sick if you
take too much though. Read up on this over the internet. There are lots
of things you can try. Keeping down your stress level, I have read, is
imperitive! I am also taking anxiety meds. occasionally for panic attacks.
I only take them in extremely bad times. I am retired and lead a pretty
calm life except for my dad having cancer. That has been very trying on my
health, but things are better now. Hope things improve for you all! Looks
like "natural" meds are our only hope. God Bless you!
Nov 5, 2008 1:08 PM
Guest
:
I was diagnosed over a year ago with SLE as my hair fell out in patches,
and I had awful problems down below, itching and soreness. I went to the GP
about the hair loss, and he was pretty quick on the uptake and I was
quickly diagnosed.I went to see a dermatologist who specialises in problems
associated with the vulva and in 2 days months of itching etc vanished with
drugs and creams, I had Lichen sclerosious. She didnt think I had
Discoid lupus and fter a couple of months my arms wrists and trunk were
covered in a rash that felt like an army of ants were crawling under my
skin, and I had to brace myself to get in a bath this for me was the
worst thing ever. I had a biopsy which showed Subcutaneous lupus, but
looking at these images I feel it is Lichen planus, I get a very sore
mouth, and have just finished anti-biotics for a urine infection and my
mouth feels burnt.I was diagnosed at 50. and it is thought that I must have
had the Lupus gene, and somewhere in my life a virus had entered and sat in
my cells and replicated, and a trauma kicked it off, at the time I had a
very stressful job and had lost my dog of 13 years which devastated me. I
have to watch my stress levels, and when I get wound up I itch more, so I
think this is stress related. I have given up with creams as these do not
help.
Nov 7, 2008 10:56 AM
Guest
:
I am a 37 year old female and the mother of two. I have had lichen planus
all over variouse parts of my body for 9 years now. The worst is of it is
having the sores in the mouth. Over the past 9 years I've been to 10
specialist and have had very little success with treatments. Most recently
however I was seen at the Mayo Clinic in Arizona and was found to have the
fist signs of oral skin cancer, do to the Lichen planus on my tong. Surgery
has been done and 1/2 of my tong had to be removed. New MRI scans just
revealed I now have internal ulcers as well. Lichen Planus can spreed
internal. My advise to anyone with this painful condition is to keep
searching for medical help no matter how stressful it gets. It's important
to remember this "skin" disorder is only the outward signs, ones
we can see, but they are signs of a more serious condition with our immune
systems. Best of luck to you all.
Nov 7, 2008 9:44 PM
Guest
:
I am a 37 year old woman who has just started treatment with a homeopathic
doctor for stubborn eczema on my elbows, and psoriasis on my scalp. The
remedy that was prescribed was a salt called Nat Mur. This remedy is also
prescribed for auto-immune disorders and Thyroid conditions which I also
have. I started the remedy 3 weeks ago and have since seen a flare up in my
skin condition. I was also recently at the dentist and was diagnosed with
oral lichen planus. I had not know what it was, or that I had this. I have
since been in touch with the homeopath who reassured me that as the body
heals through homeopathy--it can go through a healing crisis in which all
ailments are realeased through the skin. It was also suggested that I use
colloidal silver as a mouth rinse to help it if it became inflamed. I
suggest to anyone who is plagued by skin disorders such as these to try
homeopathy. I have been out of the western medical system for quite
sometime and have tried cleanses and special "candida" diets etc.
I am convinced that it is emotionally based and that homeopathics are the
way to clear these things. I have researched the remedy and the causes of
my ailments and all of it seems to fit like a puzzle. I can only be patient
and remain calm until the remedy and my body make the adjustments.
Nov 7, 2008 9:47 PM
Guest
:
I am a 37 year old woman who has just started treatment with a homeopathic
doctor for stubborn eczema on my elbows, and psoriasis on my scalp. The
remedy that was prescribed was a salt called Nat Mur. This remedy is also
prescribed for auto-immune disorders and Thyroid conditions which I also
have. I started the remedy 3 weeks ago and have since seen a flare up in my
skin condition. I was also recently at the dentist and was diagnosed with
oral lichen planus. I had not know what it was, or that I had this. I have
since been in touch with the homeopath who reassured me that as the body
heals through homeopathy--it can go through a healing crisis in which all
ailments are realeased through the skin. It was also suggested that I use
colloidal silver as a mouth rinse to help it if it became inflamed. I
suggest to anyone who is plagued by skin disorders such as these to try
homeopathy. I have been out of the western medical system for quite
sometime and have tried cleanses and special "candida" diets etc.
I am convinced that it is emotionally based and that homeopathics are the
way to clear these things. I have researched the remedy and the causes of
my ailments and all of it seems to fit like a puzzle. I can only be patient
and remain calm until the remedy and my body make the adjustments.
Nov 12, 2008 1:41 PM
Guest
:
I'm 36 and have had lichen planus (on and off) since my early 20's. I have
it on my skin and in my mouth. I, as with another poster, have recently
found that I have oral squamous cell carcinoma (cancer) on my inside cheek.
I just wanted to add to anyone interested in getting more information about
this to be attentive to the risk for mouth cancer and get regular
screenings. It could save your life!
Nov 26, 2008 2:00 PM
Guest
:
I would like to know what holistic treatments are there to treat Lichen
planus
Nov 28, 2008 4:29 PM
Elaine Moore :
Hi, I don't know of any specific holistic treatments that pertain just
to lichen planus. But there are some basic holistic principles that benefit
autoimmune disorders in general. These include strengthening and not
stimulating the immune system by avoiding known and suspected allergens,
avoiding sugar, saturated fats, chemical cleaning agents and using
immunomodulators such as German chamomile and plant sterols/sterolins.
Adding more whole foods and avoiding processed foods is another general
recommendation. Best, Elaine
Nov 29, 2008 2:02 PM
Guest
:
Hi
I read in some of your comments that people are looking for
help and support. I highly recommend the MD Junction web site. It's all
about patients helping patients: http://www.mdjunction.com/lichen-planus .
Our LP group is quite small, but it's growing all the time. We are all
there to support each other. I also write a Diary/Blog hoping that it will
shed some light on how painful LP really is:
http://www.mdjunction.com/diary/. I hope to see you all at MD Junction.
Below is a summary of my struggle with LP:
I was diagnosed
in Aug 2007. The LP is getting worse and worse. I have been on very high
doses of Prednisone and all sorts of ointments and every homeopathic
treatment out there. Nothing has worked for me. My next step is immune
suppressant drugs, which I can not afford. I don't have insurance. I have
serious low back issues and that along with LP has made my live more
painful that I could ever imagine and so I can no longer work. One
more thing - LP seems to have most Dr.'s stumped. We all need to stick
together and support each other and do whatever we can to get LP really
recognized, researched, treated and cured!!!
Dont give up!
Nov 29, 2008 2:04 PM
Guest
:
Hi I read in some of your comments that people are looking for help
and support. I highly recommend the MD Junction web site. It's all about
patients helping patients: http://www.mdjunction.com/lichen-planus . Our
LP group is quite small, but it's growing all the time. We are all there to
support each other. I also write a Diary/Blog hoping that it will shed some
light on how painful LP really is: http://www.mdjunction.com/diary/. I hope
to see you all at MD Junction. Below is a summary of my struggle with
LP: I was diagnosed in Aug 2007. The LP is getting worse and worse. I
have been on very high doses of Prednisone and all sorts of ointments and
every homeopathic treatment out there. Nothing has worked for me. My next
step is immune suppressant drugs, which I can not afford. I don't have
insurance. I have serious low back issues and that along with LP has made
my live more painful that I could ever imagine and so I can no longer
work. One more thing - LP seems to have most Dr.'s stumped. We all
need to stick together and support each other and do whatever we can to get
LP really recognized, researched, treated and cured!!! Dont give
up!
Jan 1, 2009 8:57 AM
Guest
:
i was diagnosed with LP in 2003, recieved medical treatment which ofcourse
is not a cure, regular relapse occur during the lifetime. trust me.. stress
is the only cause. chemical reactions, antio biotics, side effects of
medicines and other theories presented by the so-called qualified
dermatologists are nothing but crap.
Jan 22, 2009 3:51 PM
Guest
:
mdjunction is a website for people diagnosed with LP
Jan 22, 2009 4:10 PM
cosmickisses2u :
Have had Lichen Planus of the skin off and on for many, many years. Got
another outbreak last september after nine years in remission. I gave up on
Doctors a long time ago. Having had this disease more than half of my life,
I seem to know more than they do. Doing very well on my own with
vitamin 6, acidophilius, sea salt baths, meditation and keeping as much
stress out of my life as possible.
Jan 22, 2009 4:13 PM
cosmickisses2u :
To Jacqueline, How did you find your Chinese Herbist?
May 21, 2009 6:34 PM
Elaine Moore :
Hi, While lichen planus can occur in people with hepatitis C, most
people with lichen planus do not have hepatitis C. Best, Elaine
Jun 16, 2009 3:45 PM
Elaine Moore :
Hi, You might also want to look into some of the disorders LP is often
confused with as well as the pemphigus disorders. I hope you begin to
improve. Best, Elaine
