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Lichen Planus

What is Lichen Planus?
Lichen planus causes swelling and irritation in the skin, hair, nails, and mucous membranes.

Typical signs and symptoms include purplish, itchy, flat bumps, most often on the inner forearm, wrist, ankle and sometimes the genitals. The symptoms also include  itching & lacy white patches in the mouth or on the lips or tongue, painful sores in the mouth or vagina, hair loss,  change in scalp color and nail damage or loss. These lesions can develop and spread over the body over the course of several weeks or a few months.

Lichen planus is not usually contagious. Some rare variations might be serious and painful, and might need topical and oral medications to reduce symptoms or immunosuppressants. If the condition causes pain or significant itching, please contact your doctor.

Who gets it?
Lichen planus is common in middle-aged adults. Oral lichen planus is more common in women. However it can be seen in children and younger age groups as well.

What triggers it?
Lichen planus occurs when your immune system attacks cells of the skin or mucous membranes. The reason for such an occurrence is unknown.

It can be triggered by Hepatitis C infection, flu vaccine, allergens, stress, autoimmune disorders, genetics, certain pigments, chemicals, and metals, pain relievers such as ibuprofen and naproxen, certain medications for heart disease, high blood pressure, or arthritis, etc.

Like any autoimmune disease stress is a common exacerbating factor. A positive family history of thyroid or arthritis may also be found. There is evidence pointing to deficiency of certain micronutrients contributing to the disease process.  An increased pro oxidant to antioxidant ratio is also considered to play a role.

How is it diagnosed?
Symptoms, medical history, physical examination, and, if necessary, laboratory tests, including, but not limited to biopsy, Hepatitis C test, and allergy tests. In addition Dr Divya Sharma may prescribe certain blood tests to rule out thyroid dysfunction and other autoimmune markers.

Complications
Lichen planus on the vulva and in the vagina can cause pain, scarring, and discomfort during sex. Sexual dysfunction could be a long-term complication. However genitals LP is not so common. 

Oral sores may affect the ability to eat and the ulcerative variant of oral lichen planus can be a risk factor for carcinoma or oral cancer. The affected skin might stay slightly darker even after the rash clears up, especially in dark-skinned people. Left untreated, lichen planus of the ear canal may lead to hearing loss. 

Based on her years of experience, Dr Divya Sharma believes that Lichen planus is not a debilitating disorder and can be managed safely. All the above said complications are rarest of rare.

How is it treated?
Lichen planus on the skin is easier to treat. If the disease affects the mucous membranes, it tends to be more resistant to treatment and prone to recur.

Drugs of choice include the following:

1. Corticosteroids
Prescribed corticosteroid cream or ointment or pill or injection is the first choice for treatment. Common side effects on long term usage of topical steroids include skin irritation or thinning and oral thrush. These are safe for short-term use.

Dr Divya Sharma might reduce the potency of the prescribed ointment to prevent any long term side effects. Oral corticosteroids are rarely given to tide over an acute exacerbation. Topical steroids under supervision of Dermatologist are safe to use and may actually control the symptoms.  

2. Oral steroid sparing agents
These include the antimalarial hydroxychloroquine and the antibiotic metronidazole. Dapsone is also used in patients for maintaining the relapse. Certain immunosuppressive agents like Azathioprine can be used in patients who have frequent relapses and recurrences. 

3. Oral antihistamines
These might offer relief from itching.

4. Light therapy or phototherapy
This involves the use of narrow band ultraviolet B light for two to three sessions a week, for several weeks. It is a highly safe treatment and can be used for a longer period. It does not have any systemic side effects and does not increase the risk of Skin cancer unlike PUVA. The results take 4 to 6 weeks to show and are slower in the beginning.

5. Retinoids
Retinoids are considered in severe cases as they can cause birth defects. Therefore these drugs are not recommended for women who are pregnant or may want to conceive. Otherwise Acitretin is a very effective drug used in patients who cannot be put on immunosuppressive drugs. 

Self-care measures
Self-care measures can help reduce itching and discomfort. These include:

  • Soaking in a bathtub with colloidal oatmeal, followed by moisturizing lotion

  • Applying cool compresses

  • Avoiding scratching or injuring your skin

  • Maintaining good oral hygiene and regular dentist visits

  • Avoiding smoking, drinking alcohol, consuming spicy or acidic food and drink, etc. especially if you are suffering from oral Lichen planus.

  • Ensuring regular exposure to sunlight is helpful

  • Avoiding trauma when disease is active to prevent spread of lesions

  • Exercising regularly to prevent weight gain as autoimmune diseases aggravate on weight gain.

At Dr Divya’sskin and hair solutions Clinic, we offer safe, effective treatment taking into consideration your long term safety.

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