Lichen planus treatment

Lichen planus (Wilson's lichen) — is a chronic inflammatory disease of the skin and mucous membranes, which can manifest as itchy rashes on the skin, lesions of the oral mucosa, changes in the nails, or rashes on the hairy part of the head. It should not be confused with fungal lichen: lichen planus — is an autoimmune disease associated with a disorder of the immune response, not an infection.

At the Oxford Medical clinic, you can receive a consultation from an experienced dermatologist. The doctor will assess the form of the disease, the severity of the symptoms, and select treatment aimed at reducing itching, discomfort, and the risk of repeated exacerbations. Make an appointment at a time convenient for you by phone or through the online appointment form on the website.

The exact cause of the development of lichen planus has not been fully established. According to the American Academy of Dermatology, the disease is associated with a disorder of the immune response, when the immune system mistakenly attacks its own skin cells or mucous membranes. That is why lichen planus in a person can have a prolonged or recurrent course.

Its development or exacerbation can be provoked by various factors:

• chronic stress and overwork;
• infectious diseases;
• taking certain medicinal preparations;
• injury to the skin or mucous membrane;
• concomitant chronic diseases.

In each patient, the combination of factors can be different, therefore it is often impossible to determine one specific cause. During the consultation, the dermatologist clarifies when the rashes appeared, whether there were exacerbations after stress, taking medicines, infections, injury to the skin or irritation of the mucous membrane. This helps to better understand the course of the disease and assess possible factors that support inflammation.

On the skin, rashes often have a shiny surface, clear borders, and can group into small plaques. Most often, they appear on the wrists, shins, torso, lower back, or in areas of friction. When the mucous membranes are affected, the patient may be bothered by burning, pain during eating, increased sensitivity to spicy, acidic, or hot foods.

Doctors of Oxford Medical note: if lichen planus affects the hairy part of the head, hair loss in separate areas is possible. With changes in the nails, the plates may become thinner, uneven, brittle, or gradually deform. Such manifestations require an examination by a doctor, since without treatment they can progress.

In dermatology, forms of the disease are described by localization — on the skin, mucous membranes, nails, or the hairy part of the head, as well as by the clinical features of the rash. This helps to more accurately assess the course of the disease and select treatment.

By localization, the following are distinguished:

• skin form — manifests as small reddish-purple papules or plaques, which are often accompanied by itching and may appear on the wrists, shins, torso, lower back;
• oral form — affects the mucous membrane of the mouth and may manifest as whitish reticular lines, spots, erosions, burning, or soreness during eating;
• genital form — occurs on the mucous membranes of the genital organs and may cause itching, burning, soreness, or discomfort;
• nail form — is accompanied by grooves, brittleness, thinning, splitting, or deformation of the nail plates;
• follicular form, or red hair lichen, — affects the hair follicles, most often on the hairy part of the head, and may lead to areas of hair loss.

By the nature of the rashes, the following are distinguished:

• typical papular — manifests as small shiny reddish-purple papules, which may group into plaques;
• hypertrophic — is accompanied by the appearance of dense thickened plaques, which often itch severely and are more often located on the shins;
• erosive-ulcerative — is characterized by painful erosions or ulcers, which more often occur on the mucous membranes;
• atrophic — manifests as areas of thinning of the skin or mucous membrane after a prolonged inflammatory process.

The form of the disease affects the tactics of treatment. That is why during the examination the doctor carefully assesses all features.

Diagnosis of lichen planus begins with an examination of the skin, mucous membranes, nails, and the hairy part of the head. In typical cases, a dermatologist may suspect lichen planus already during the examination. To clarify the diagnosis, dermatoscopy may be performed — examination of the skin using a special device with multiple magnification and illumination. This helps to better examine the structure of the elements, the borders of the rashes, scaling, and other signs that are important for differential diagnosis.

According to the American Academy of Dermatology, diagnosis of lichen planus usually begins with an examination of the skin, mucous membranes, nails, or the hairy part of the head. If the diagnosis needs clarification, the doctor may prescribe a biopsy — taking a small tissue sample for laboratory testing.

Additional tests are prescribed not for all patients, but only according to indications. These may include:

• biopsy of the skin or mucous membrane with histological examination — if the clinical picture is atypical and the diagnosis needs to be confirmed;
• mycological examination — if there is a need to exclude a fungal lesion;
• blood tests — if the doctor suspects concomitant diseases or a possible connection between the rashes and the general condition of the body.

If there is a lesion of the mucous membrane of the mouth, genital organs, nails, or the hairy part of the head, the dermatologist may recommend a consultation with the relevant specialist — a dentist, gynecologist, urologist, or trichologist. This is needed to assess the specific affected area and choose safe treatment tactics.

Doctors of Oxford Medical explain: lichen planus may be similar to psoriasis, eczema, candidiasis, fungal lesions, leukoplakia, lupus erythematosus, and other conditions. Therefore, diagnosis must be consistent: first a clinical examination, if necessary — dermatoscopy, and in case of an uncertain picture — biopsy with histological examination.

Treatment of lichen planus is selected individually. The tactics depend on the form of the disease, the localization of the lesions, the severity of the symptoms, and how often exacerbations occur.

Main directions of treatment:

• Local therapy — is used for limited rashes on the skin or mucous membranes. It may include anti-inflammatory preparations in the form of ointments, creams, gels, solutions, or other local agents.
• Systemic therapy — is prescribed in widespread, prolonged, or recurrent course, when local treatment is not sufficient. It may include preparations that affect inflammation and the immune response.
• Phototherapy — may be used in certain skin forms of the disease. This is one of the variants of physiotherapeutic procedures that are used in certain forms of lichen planus.

Doctors of Oxford Medical note that there is no universal therapy scheme. Treatment of lichen planus should be selected by a doctor after examination and clarification of the form of the disease. Independent use of hormonal ointments, alcohol solutions, or other agents may intensify irritation, change the appearance of the rashes, and complicate further diagnosis.

There is no specific prevention of lichen planus. However, it is possible to reduce the risk of exacerbations and irritation of the skin or mucous membranes if the factors that may support inflammation are controlled.

Main recommendations:

• do not injure the skin and do not scratch the rashes;
• do not use hormonal ointments, alcohol solutions, and other agents without a doctor's prescription;
• control chronic diseases and treat infectious processes in a timely manner;
• avoid prolonged stress, overwork, and other factors that may weaken the body;
• in case of damage to the mucous membrane of the mouth, regularly visit a dentist to eliminate traumatic factors: sharp edges of teeth, low-quality dentures, fillings, or other sources of irritation.

If lichen planus has a recurrent course, it is important to undergo follow-up examinations with a dermatologist. This helps to notice an exacerbation in time, adjust treatment, and reduce the risk of prolonged discomfort.

The price of treatment of lichen planus depends on the form of the disease, localization of the lesions, severity of the symptoms, the need for additional diagnostics, and the scope of the prescribed therapy. You can preliminarily familiarize yourself with the prices for doctors' consultations and other medical services here.

In the Oxford Medical medical centers, you can receive a consultation from a dermatologist and undergo the necessary diagnostics in a convenient location — on the right or left bank of Kyiv, as well as in Irpin. To make an appointment, leave a request through the contact center or the online form on the website.

The information is for informational purposes and does not replace a doctor's consultation.

Sources:

• American Academy of Dermatology
• NCBI Bookshelf
• DermNet