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Lichen Planus: Symptoms, Diagnosis, Treatment, and Risks

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Lichen planus is a chronic, itchy rash that can appear in just one area of the body or affect several parts of the body at the same time. Most commonly, it is seen on the skin of the arms and legs and inside the mouth. Lichen planus can also affect the nails and the skin in the genital area.

Lichen planus

What are the symptoms of lichen planus?

  • On the skin, lichen planus causes itchy groups of bumps that are shiny, firm and slightly purple.
  • Lichen planus in the mouth may be painful and look like a white lacy rash.
  • Lichen planus of the nails causes distortion including ridges and grooves.

Variants of the disease may include lesions that look like blisters and ulcers, and those that look similar but are induced by a medication-adverse reaction. Lichen planus of the scalp, or lichen planopilaris, may be itchy or painful and cause alopecia (hair loss).

What causes lichen planus?

The cause is not completely clear but is likely a combination of an autoimmune reaction and environmental triggers.

Environmental factors include viruses (particularly hepatitis C), medications and allergic reactions to a foreign substance including metallic dental materials. It is important to tell your doctor about all the medications you were taking when you first noticed the rash.

How is lichen planus diagnosed?

Lichen planus is usually diagnosed by a healthcare provider who specializes in skin conditions. This is most often a dermatologist, but a primary care physician, physician assistant or nurse practitioner may also have special expertise in this area.

While lichen planus can be diagnosed at your appointment, you may need a biopsy (having a small sample of skin removed to be examined) to confirm. Blood testing may also help your healthcare provider.

How is lichen planus treated?

There is no cure for lichen planus, although it may resolve spontaneously (without treatment).

Your doctor can advise you on some treatments that can help. You may need to adjust some of your other medications. Other treatments depend on the area of the body involved but may include:

  • Creams or injections of steroids targeting the rash
  • Light therapy
  • Oral pills, including some that may affect the immune system

What is the outlook for lichen planus?

A majority of cases of lichen planus go away within 1 year if it is just on the skin. If involving the mouth the rash may be more severe, take longer and require treatment.

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