Image Courtesy of James Heilman, MD via Creative Commons license, some rights reserved.

Lichen planus is a common skin disease. It occurs due to immunological imbalance and dysfunction. Lichen planus sometimes associates with some autoimmune disorders like myasthenia gravis, thymoma, and Graft Versus Hast Disease (GVHD). It is a noncontagious, noninfectious itchy condition.

SIGNS AND SYMPTOMS

• ITCHING – Itching is the most common and most significant symptom of lichen planus.
• RASH – Purple colored rash with elevated top over the skin is seen in lichen planus. Rashes are commonly visible over hands, legs, wrist, and ankles.
• BLISTERS – Blisters may occur during the course of the disease. Blisters are broken later and form a scab.
• HAIR LOSS – lichen planus may involve scalp and causes cicatricial alopecia.
• ULCER – lichen planus affects mucous membranes covered areas like mouth or genitals. It causes an oral ulcer or a vaginal ulcer or a penile ulcer. These ulcers are very painful.

TRIGGER FACTORS

• Hepatitis C virus infection

• NSAIDs group of drugs like Naproxen Sodium, Ibuprofen, etc.

• Dyes

• Stress

• Flu Vaccine

• Certain chemicals

• Genetic Factors – Familial bullous lichen planus is a rare variety of lichen planus having a genetic association.

DIAGNOSIS

Dermatologists diagnose lichen planus by proper history taking and clinical examination. The majority of cases do not require any investigation. When the diagnosis is uncertain, the doctor may ask for a skin biopsy. Dentists often diagnose oral lichen planus. sometimes the doctor asks for serological tests to diagnose hepatitis C infection.

TREATMENT

There are various treatment modalities according to the severity of the disease. For the mild cases where minimum symptoms present no treatment required. For moderate and cases topical corticosteroid is the most specific treatment. Commonly used topical steroids are Betamethasone, Fluticasone, Clobetasol, Halobetasol, Diflorasone, Mometasone. These are avoidable in the market in various forms like ointment, cream, gel, etc. Topical steroids reduce itching and inflammation. Severe lichen planus or steroid-resistant lichen planus are treated with Tacrolimus or Pimecrolimus ointment. Tacrolimus and Pimecrolimus are calcineurin inhibitor group of drugs. They act by altering the body’s immune system .