17723 Lichen Planus

Overview

Lichen planus is a skin condition that causes an itchy, bumpy rash. It can also affect the inside of your mouth, nails, and scalp. It is not an infection and cannot be passed from person to person.

Lichen planus is not very common. It affects about 1 in 100 people worldwide.

It can happen at any age, but it is most often seen in adults between 30 and 60 years old. Oral lichen planus is more common in women.

Symptoms

Common symptoms

• Purple or reddish-purple flat-topped bumps on the skin, often on the wrists, lower legs, or back.
• Severe itching.
• Lacy white patches inside the mouth.
• Painful sores or burning feeling in the mouth.
• Changes in nails, such as ridges or splitting.
• Scalp redness, scaling, or hair loss.

Symptoms in children

• Lichen planus is rare in children. When it does occur, it may look similar to other rashes. Children may have itchy bumps, often on the arms and legs. Mouth sores are less common in children.

Symptoms in older adults

• Older adults may experience lichen planus more on the legs and in the mouth. Mouth symptoms can be painful and may make eating uncomfortable. Skin changes may be drier and more scaly.

Causes

Main causes

• The exact cause is not known, but it is likely an autoimmune reaction — your immune system attacks healthy skin cells by mistake.
• Certain medicines, vaccines, or chemicals may trigger lichen planus-like rashes in some people.
• It is not caused by stress, but stress can make symptoms worse.

Risk factors

• Being an adult aged 30 to 60.
• Having a condition like hepatitis C, which is sometimes linked to lichen planus.
• Taking certain medications or having contact with dental metals.

When to see a doctor

See a doctor urgently if:

• If you have severe mouth pain that stops you from eating or drinking.
• If you think the rash is infected.

Book a routine appointment if:

• If you have a rash that lasts more than a few weeks and is itchy or uncomfortable.
• If you notice white patches or sores in your mouth that do not go away.
• If you have changes in your nails or hair loss that worry you.

Diagnosis

Your doctor or a skin specialist (dermatologist) will usually diagnose lichen planus by looking at your skin, mouth, or nails. They may ask about your medical history and any medicines you take.

Tests that may be done

• Sometimes a skin biopsy — removing a tiny piece of skin to be checked under a microscope.
• Blood tests may be done to check for conditions like hepatitis C.

What to expect at your appointment

A biopsy is quick and uses a small sample of skin. The area is numbed first, so you should not feel pain. Results take a week or two.

Treatment

Treatment focuses on relieving symptoms and helping the rash clear. Many people do not need treatment unless symptoms are bothersome. The condition may go away on its own within a year or two, but some people have flare-ups over time.

Self-care at home

• Use cool compresses or take a cool bath to calm itching.
• Apply plain moisturizers (unscented) to dry, itchy skin.
• Avoid scratching — keep nails short and wear loose clothing.
• For mouth sores, eat soft, bland foods and avoid spicy, acidic, or rough-textured foods.
• If you think a medicine or dental material is causing the rash, talk to your doctor or dentist (but do not stop a prescription medicine on your own).

Medical treatments

Your doctor may recommend prescription creams or ointments to reduce inflammation. For widespread or severe cases, treatments may include light therapy, tablets, or injections. Any treatment should be discussed with your healthcare provider — do not use over-the-counter products without asking first.

When is surgery considered?

Surgery is not usually needed for lichen planus. In very rare cases, oral lichen planus that does not respond to other treatments might be treated with a minor procedure, but this is uncommon.

Living with this condition

Lichen planus can be uncomfortable, but daily habits can help. Keep skin moisturized, wear soft, breathable fabrics, and avoid harsh soaps and detergents.

Lifestyle tips

• Manage stress with activities you enjoy, such as walking, reading, or talking to friends.
• If you smoke, consider quitting — smoking can worsen mouth lichen planus.
• Protect your skin from sun, since some treatments can make skin more sensitive.

Diet and exercise

There is no special diet that cures lichen planus, but eating a balanced diet with plenty of fruits, vegetables, and water helps keep your body healthy. Gentle exercise can improve your mood and reduce stress. For mouth sores, choose softer foods and let drinks cool slightly before drinking.

Mental health and emotional wellbeing

Itching and pain can interfere with sleep and daily life, and the visible rash can affect how you feel about yourself. It is normal to feel frustrated or anxious. Talk to your doctor if you feel low or worried. If you are in emotional distress and need to talk to someone right away, contact your local mental health crisis helpline or go to a hospital emergency department.

Prevention

Because the exact cause is unknown, there is no sure way to prevent lichen planus. If you notice that certain medicines or dental materials trigger your symptoms, avoiding those triggers may help. Keeping stress in check may also reduce flare-ups.

Vaccines

There is no vaccine for lichen planus.

Screening programmes

There is no standard screening test for lichen planus. Regular skin checks with your doctor can help identify any changes.

Complications

If left untreated

• Persistent itching can lead to skin infection from scratching.
• Oral lichen planus can cause painful sores and may slightly increase the risk of mouth cancer over time — this is why regular dental and medical checks are important.
• Scalp lichen planus can lead to permanent hair loss if not treated.

Long-term outlook

For most people, lichen planus clears up within 18 months, though some have it for years. Treatment can control itching and pain, and most people live full, active lives. If you have oral lichen planus, keep up with regular check-ups so any changes can be caught early.

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