Lichen planus

Overview

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

Lichen planus is not very common, but it affects about 1 in 100 people worldwide.

It can affect people of any age, but it is most common in middle-aged adults. It is slightly more common in women than men. It rarely affects children.

Symptoms

Common symptoms

• Purple, flat-topped bumps that are very itchy
• White, lacy patches inside the mouth (oral lichen planus)
• Thin, white lines on the bumps (called Wickham's striae)
• Blisters or ulcers in the mouth that may hurt
• Nail changes like ridges or thinning
• Scalp redness, scaling, and sometimes hair loss

Symptoms in children

• Lichen planus is rare in children, but if it occurs, it looks similar to adults—itchy purple bumps. It may be more likely to affect the mouth in children.

Symptoms in older adults

• In older adults, the rash may be less itchy and can last longer. It may also affect the mouth more often.

Causes

Main causes

• The exact cause is unknown, but it is thought to be an immune reaction where your body attacks its own skin cells.
• Sometimes it can be triggered by certain medications, vaccines, or infections like hepatitis C.
• In some cases, it may be linked to metal fillings in your teeth.

Risk factors

• Having hepatitis C infection
• Taking certain medications (e.g., some blood pressure drugs, pain relievers)
• Having a family history of lichen planus
• Stress may make symptoms worse

When to see a doctor

See a doctor urgently if:

• If you have a very painful mouth ulcer that prevents you from eating or drinking.
• If the rash spreads rapidly or blisters develop on a large area.
• If you have signs of a secondary infection (fever, warmth, oozing).

Book a routine appointment if:

• If you have an itchy rash that does not go away after a few weeks.
• If you notice changes in your nails or scalp that concern you.
• If you have white patches or sores inside your mouth that last more than two weeks.

Diagnosis

Your doctor can often diagnose lichen planus by looking at your skin, mouth, nails, or scalp. They may use a special light or magnifying tool to see the rash more clearly. In some cases, a small skin biopsy (removing a tiny piece of skin to examine under a microscope) is done to confirm the diagnosis.

Tests that may be done

• Physical exam
• Skin biopsy (if needed)
• Blood tests to check for hepatitis C or other triggers

What to expect at your appointment

The diagnosis is usually straightforward. Your doctor will ask about your symptoms and medical history. If a biopsy is done, the area will be numbed first, and you may have a small stitch. Results take a week or two.

Treatment

Treatment aims to relieve itching and speed up healing. Mild cases may not need any treatment. For more bothersome symptoms, your doctor may recommend creams, ointments, or medications that calm the immune system. For oral lichen planus, special mouth rinses or sprays may be used. Always follow your doctor's advice.

Self-care at home

• Use cool compresses or oatmeal baths to soothe itching.
• Avoid scratching – keep nails short and wear cotton gloves at night.
• Use gentle, fragrance-free skin care products.
• Avoid foods that irritate your mouth (spicy, acidic, or rough foods) if you have oral lichen planus.
• Manage stress with relaxation techniques.

Medical treatments

Your doctor may prescribe topical corticosteroids (creams or ointments to reduce inflammation and itching). For severe cases, oral medications that modify the immune response may be used. Light therapy (phototherapy) can also be helpful. For oral lichen planus, corticosteroid mouth rinses or adhesive pastes may be prescribed. Do not use over-the-counter treatments without advice.

When is surgery considered?

Surgery is not usually needed for lichen planus. In rare cases, if the rash causes scarring or hair loss, procedures like laser therapy may be considered, but this is not common.

Living with this condition

Living with lichen planus can be frustrating because of the itching. But the condition often improves over time. Stick to your treatment plan and keep your skin and mouth clean and moisturized. Avoid harsh soaps and perfumes.

Lifestyle tips

• Wear loose, soft clothing to avoid irritating the skin.
• Use a humidifier at home to keep skin from drying out.
• Avoid alcohol and tobacco, as they can worsen oral symptoms.
• Practice good oral hygiene with a soft toothbrush.

Diet and exercise

A balanced diet helps your immune system. If you have mouth sores, avoid spicy, salty, or acidic foods. Staying active can help reduce stress, which may improve symptoms.

Mental health and emotional wellbeing

The itching and visible rash can be stressful and affect your mood. It is normal to feel frustrated or self-conscious. Talk to your doctor if you feel anxious or depressed. Support groups can also help. Remember, help is available – if you need immediate support, call a crisis line.

Prevention

There is no known way to prevent lichen planus because the exact cause is not clear. However, avoiding known triggers (like certain medications if you are sensitive) may help. If you have hepatitis C, treating that infection may reduce your risk.

Complications

If left untreated

• Scarring or permanent changes in skin color (hyperpigmentation)
• Permanent nail damage
• Hair loss (scarring alopecia) if the scalp is affected
• Increased risk of mouth cancer if you have long-standing oral lichen planus – regular dental check-ups are important

Long-term outlook

Most cases of lichen planus clear up on their own within 18 months, though it can last longer. Treatment can control symptoms and prevent complications. If you have oral lichen planus, you should have regular check-ups to monitor for any changes. With proper care, most people manage well.

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