DEAR DOCTOR: Recently, my skin became irritated and started blistering. I was diagnosed with lichen planus, which I'm told is pretty common. What is it? How can people deal with the irritation and itchiness it causes?
DEAR READER: Lichen planus is a condition in which swelling, irritation and inflammation develop on various areas of the body. You're correct that it's common. And although lichen planus is most often seen on the skin, as in your case, it can also occur on the scalp, nails and mucous membranes.
The specific symptoms depend on the area of the body that is affected. On the skin, lichen planus appears as flat, itchy bumps with a reddish or purple color. These are usually firm and sometimes quite shiny. When it appears on mucous membranes, such as the inside of the cheek, the gums, the tongue or the genitals, it presents with clusters of tiny white dots that can look like lace. These may be accompanied by sores or inflammation that is often painful. On the scalp, the condition sometimes results in hair loss. Individuals with lichen planus on the nails often see thinning or splitting, develop marked ridges or grooves, and may experience nail loss that can be temporary or sometimes permanent.
Although the specific causes of the condition are not yet known, it is suspected to be a disease of the immune system.
Diagnosis of lichen planus is typically done with a physical and visual exam of the affected area, and by taking a sample of skin or a sore to examine under a microscope. Because the symptoms can be similar to several other skin conditions, including eczema and psoriasis, a blood test may be used to further narrow down the diagnosis.
There is no cure for lichen planus at this time, so the focus is on managing the symptoms. This includes using antihistamines to alleviate itchiness, and topical corticosteroid creams or ointments to help with swelling and redness. Retin A and certain types of light therapy have been found to be useful in helping to clear up the skin. For some patients, the prescription ointments prescribed for eczema are helpful. And in severe cases of lichen planus in which a patient has large areas of sores or bumps or experiences extreme itchiness or pain, corticosteroids such as prednisone, delivered as a pill or an injection, can provide relief.
When the condition develops in the mucous membranes, such as inside the mouth or on the genitals, the moist and enclosed environments make treatment more challenging. In the genitals, it can cause enough pain to interfere with sex. Sores in the mouth can make eating more difficult. Lichen planus also increases the risk of gum disease, which makes dental hygiene, including professional teeth cleaning, vital.
The good news is that the condition will often go away on its own over the course of a year or two. However, about 20% of people experience a recurrence. It's not contagious, but there is evidence that some forms of lichen planus can run in families. Since people living with hepatitis C often also develop lichen planus, researchers are now exploring possible connections between the two.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.