Lichen planus, also a fairly common skin disease. One of those autoimmune skin disorders like psoriasis, it is seen in about 0.5 to 2% of the population in our country. We can observe relatively higher levels of anxiety and mental depression in people suffering from lichen planus. It is an inflammation in the skin which is shown out in the form of lesions, rashes, redness, and papules with itching.
There are types in the lichen Planus depending on the morphology. Hypertrophic, atrophic, ulcerative, actinic, follicular, vesiculobullous etc.
Based on the cause, they are drug lichenoides keratitis, lichenoid dermatitis etc.
It is a non-infectious chronic disorder but not a contagious one. This may be confined to a certain part of the body or spread to several areas of the body. It can be spotted inside the mouth, scalp and even genitals too apart from the skin. It can bring a change in the appearance of the nail colour and shape. On the skin, it’s mostly seen on the feet and the wrists. It can affect the mucous membranes also. A lichen planus manifests swelling with irritation. It is pink to purple in colour, forming patches and sores spreading to several parts of the body. It is manageable up to a mild and typical stage. If it signs are beyond to handle, prescribed drugs and treatment is necessary.
What causes lichen planus?
The exact causative factor for lichen planus is merely known. However, there are many assumptions about the responsible factors for the disorder. Most of the studies put forth it as an autoimmune disorder of the immune system. But the reason for the immune response is stated in many ways.
First of all, it may result when as a T-cell mediated immune response to epithelial skin cells which are mistaken for a foreign body by the immune system. The skin cells even show a change in their structural surface, which is also a reason for the immune response to begin and basal cell damage to occur. Some lichen planus can also occur as an allergic immune response to certain medications and drugs. Beta-blocker drugs that act on the cardiovascular system, to lessen the impact of contractions of cardiac muscle, to lower the rate of heartbeat, that de-stresses the heart and its blood circulation and also neurological medications may trigger the immune responses which end up with this chronic skin disorder. Tranquillizing drugs that act against psychotic behaviour and anti-inflammatory medications are also enlisted as causative factors. People with hepatitis C may also catch up with lichen planus.
Other factors that contribute to the onset of this severe outbreak are viral infections, allergens or allergy-causing agents, stress and genetic factors. Lichens Planus can be seen in any age group. In children, it is less appreciated than adults. Women have twice the risk than men, but the impact and appearance of the disease are equal irrespective of gender. However, middle-aged adults are highly victim of this lichen planus. The allergy-causing agents include gold, arsenic, iodide, antibiotics, antimalarial drugs, anti-inflammatory drugs, diuretics and certain dyes, flu vaccines, painkillers like ibuprofen, aspirin and Advil, naproxen etc.
Symptoms and signs of lichen planus:
Flat bumps that are purple in colour can be spotted on the skin and also in genitals in both males and females, they may be even lesions. They may be confined to a certain part or spread to various parts of the body in a few weeks to a few months. They gradually develop itching and swelling with inflammation. These lesions may develop into blisters which often bursts and go scabby. White scales form over the rashes. The lesions that form in the mouth are white and have a burning sensation.
A most common demonstrated symptoms of the disease is scaly and rough skin. The bumps are called apples. Bumps on the next level develop into thick patches of scaly skin, seen usually on the chin and ankles along with wrist. These are irritating and itching arises. Blisters are the rarest.
The lesions are reddish and painful on the genitals. Burning sensation, discharges are seen in the genitals. Intercourse becomes impossible with this lichen planus. Open sores are more taunting.
The lichen planus that appeared in the mouth are commonly seen inside the cheeks, tongue, tooth gums and lips. They are red, white yeast like dots that form painful sores, affecting the gums. They create discomfort while eating and drinking. This other way is responsible for recurring ulcers in the mouth.
The nails get split or lost temporarily or permanently. Grooves or deformations occur on the nails. Thinning of nails can be observed. When it comes to the scalp, lichen planopilaris is seen with patches of scaly and rough skin. These are itchy, red and causes hair loss. This condition is called scalp psoriasis.
Diagnosis of the lichen planus:
Biopsy, hepatitis C test, allergy tests are the lab tests done in the diagnosis of lichen planus. These are prescribed based on the symptoms, background history and after examining physically. A dermatologist concern would be suggested if confirmed. In a biopsy, a small specimen of the affected skin tissue is taken. It is examined under the microscope, the cell structure and characteristic differences are seen. The tissue is analyzed and the disease is confirmed.
In the hepatitis C test, a blood sample is taken to test, as it is a causative factor for lichen planus. The allergens trigger the planus most effectively, hence the dermatologist carries on the series of allergy tests to find the allergy-causing agents for the lichen Planus outbreak. Depending on the affected area like mouth, cheeks, ears, genitals, head, oesophagus etc, different rests and examinations are further carried out by the dermatologist.
Treatment plans and medications for lichen planus:
There is no specific cure for lichen planus. Mild cases of this disorder don’t need any treatments prescribed and usually clears up in a few days to weeks. The disorder affecting the mucous membrane is the thing to worry about, as it becomes resistant to the treatment and recurs. If the signs still persist more than weeks, doctors go for medication.
The medications usually involve steroids hence prone to side effects. Topical medication is the first line of defence. Corticosteroid ointments and creams are given, if it didn’t help the situation, the corticosteroid pills or injections are prescribed instead. The complications of the dosages include irritation, itching, thrush and thinning. Usually prescribed only for short periods. Oral anti-infection drugs, like antimalarial and antibiotics, are used to treat the infection.
The suppressant medicines like azathioprine, mycophenolate, cyclosporine and methotrexate are suggested to calm down the situation. Light therapy with or without laser is directly applied on the affected skin. Mostly UV light is used to penetrate the epidermal layer. Light rays make the skin darker, hence not recommended for dark-skinned people.
Retinoids come third such as acitretin. They can cause defects in pregnancy. Hence the topical application of retinoids is avoided, stopped or delayed in pregnant women. Birth defects risks are the effects of retinoids. Antihistamine drugs are suggested to control the itching. They are most effective in relieving the irritation caused. The people with lichen planus show reportedly higher levels of anxiety, depression and psychotic behaviour. Tacrolimus ointment and pimecrolimus cream are used to treat skin problems and eczema.
Ayurveda suggests the extract of curcumin also called turmeric and it’s ingredients as chemopreventive agents, they prevent oral cancers, inflammation. This acts as an antioxidant, anticancer and anti-inflammatory ingredient. This is a naturally available resource and without side effects. Lichen planus goes away in a couple of years. Rarely one of five experiences a second come back. Lichen planus of the oral cavity stays longer than of skin. This disorder leaves dark spots as it ages and heals. To light these spots, a dermatologist may suggest creams, ointments and even laser treatments.
Lichen planus is not avoidable but it can be stopped from recurring with continuing the treatment plan honestly. Dermatologist visits and suggestions handle the condition in the most useful way. The medications for this disease should not be taken on self, should always use the prescribed drugs. When you find bumps, with redness for no apparent reason on your skin and mucous membranes, or as an allergic reaction to any poison or medication, you got to reach out to the doctor. Experiencing the symptoms of lichen planus on the nails, skin and genitals should not be ignored. A wrong or delayed diagnosis may worsen the disease taking it to the next level.