Lichen Planus (LP) is a chronic, inflammatory condition affecting skin, mucous membranes, and nails. It’s an autoimmune disorder where the body’s immune system mistakenly attacks its own cells, leading to various symptoms. While the exact cause remains unclear, LP is believed to be triggered by factors like stress, certain medications, and infections such as hepatitis C. This blog delves into the different presentations of LP, focusing on its oral, genital, and skin manifestations, providing insights into their prevalence, symptoms, and management.
What Is Lichen Planus?
Lichen Planus is characterised by flat, purplish, itchy lesions that can appear on the skin, mouth, and other mucous membranes. The condition is more common in adults, particularly between the ages of 30 and 60, and has a higher prevalence in women. While LP is not life-threatening, it can cause significant discomfort and, in some cases, lead to complications like scarring or an increased risk of oral cancer.
Oral Lichen Planus (OLP)
Prevalence and Demographics
Oral Lichen Planus affects approximately 1% to 4% of the general population. In India, a study found a prevalence of 2.6%, with a notable female predominance. The condition is rare in children, representing less than 5% of all affected patients.
Clinical Features
OLP typically presents as white, lacy patches (reticular form) inside the mouth, often on the buccal mucosa (inner cheeks), gums, tongue, and lips. Other forms include:
- Erosive: Painful, red, and ulcerated areas.
- Atrophic: Thinning and redness of the mucosa.
- Plaque-like: Raised, white patches resembling leukoplakia.
Patients may experience symptoms like burning sensations, especially when consuming spicy or acidic foods.
Complications
While OLP itself is not cancerous, it is considered a potentially malignant disorder, with a small risk of transformation into oral cancer (approximately 1% to 4%). Therefore, regular monitoring by dental and medical professionals is crucial.
Genital Lichen Planus (Vulvar and Vaginal)
Prevalence and Gender Differences
Genital involvement is less common than oral or skin manifestations, but still significant. Studies indicate that 19% of women with OLP have genital involvement, compared to 4.6% of men.
Clinical Features
In women, genital LP primarily affects the vulva and vagina, presenting as:
- Vulvar Lichen Planus (VLP): Red, inflamed areas, sometimes with white striations.
- Vaginal Involvement: Less common but can cause discomfort during intercourse, vaginal discharge, and pain during urination.
Diagnosis and Management
Diagnosis of genital lichen planus is confirmed through clinical examination and biopsy. Treatment options include topical corticosteroids to reduce inflammation and alleviate symptoms. In some cases, systemic treatments may be necessary. Regular follow-up is essential to monitor for potential complications.
Cutaneous (Skin) Lichen Planus
Prevalence and Demographics
Cutaneous LP is estimated to affect approximately 0.2% to 1% of adults worldwide. It is more common in adults aged 30 to 60 and has a higher prevalence in women.
Clinical Features
Skin lesions typically appear as:
- Flat-topped, purple papules: Often found on the wrists, ankles, lower back, and genital areas. A study involving 78 patients with LP found that 94.9% of patients experienced pruritus (itching), with most episodes lasting longer than one minute.
- Itching: A common symptom that can vary in intensity.
Less commonly, LP can affect the scalp (leading to hair loss), nails (causing pitting or ridging), and mucous membranes.
Management
Treatment focuses on relieving symptoms and may include:
- Topical corticosteroids: To reduce inflammation.
- Phototherapy: For widespread or resistant cases.
- Systemic treatments: In severe or generalized cases.
It’s important to note that while cutaneous LP can resolve on its own, treatment may be necessary to manage symptoms and prevent complications.
Extraoral Involvement
LP can also affect other areas, though less commonly:
- Scalp (Lichen Planopilaris): Leads to scarring alopecia (permanent hair loss).
- Nails: Can cause pitting, ridging, and in severe cases, nail loss.
- Esophagus: Rare but can cause swallowing difficulties.
- Eyes: Conjunctival involvement is extremely rare but possible.
Regular monitoring and early intervention are key to managing these manifestations effectively.
Diagnosis and Treatment
Diagnosis
LP is diagnosed based on clinical examination and confirmed through biopsy. Histopathological examination reveals characteristic features, aiding in distinguishing LP from other similar conditions.
Treatment
Treatment aims to alleviate symptoms and prevent complications. Options include:
- Topical corticosteroids: First-line treatment for localized lesions. For instance, a prospective follow-up study of 570 patients with OLP found that 75% were treated with corticosteroids, leading to complete remission in 29% and partial remission in 63%.
- Systemic corticosteroids: For widespread or severe cases.
- Immunosuppressive agents: In cases resistant to other treatments.
- Phototherapy: For extensive skin involvement.
Lifestyle modifications, such as avoiding triggers (e.g., certain foods, stress), can also help manage symptoms.
Living with Lichen Planus
While LP is a chronic condition, many individuals manage it effectively with appropriate treatment and lifestyle adjustments. Regular follow-ups with healthcare providers, including dermatologists and dentists, are essential for monitoring the condition and adjusting treatment as needed.
Support groups and counseling can also be beneficial, as dealing with a chronic skin or mucosal condition can impact mental and emotional well-being.
All About Lifestyle
A Reddit User explains that they deal with oral lichen planus, and the healing process has always been elusive. However, symptom management has been successful through disciplined lifestyle choices. They’ve found that avoiding common triggers like spicy food, alcohol, coffee, and dairy—along with prioritizing quality sleep and effective stress management—makes a significant difference. However, when this routine slips, even for a few weeks, flare-ups tend to return, highlighting the persistent nature of chronic OLP.
Systematic Approach to Symptom Management
Another Reddit User says that they have been managing chronic oral lichen planus for five years. While not cured, they find some relief using clobetasol gel on gauze applied to affected areas, along with an iodine-based mouthwash (ioRinse) and Fluorimax 5000 toothpaste, both prescribed by their dentist. They also use ultra-soft Dr. Collins Perio toothbrushes.
Diet plays a big role—spicy foods, carbonated drinks, chocolate, and possibly fried foods can trigger pain. Despite living in Louisiana, they’ve had to give up staples like Tabasco and pepper-heavy dishes.
Dr. Dray Explains
You can also check out this insightful video by Dr. Dray, wherein she explains the causes and treatment options of lichen planus.
Lichen Planus: A Multifaceted Condition
Lichen Planus is a multifaceted condition that can affect various parts of the body, including the oral cavity, genital area, and skin. Understanding its different presentations, prevalence, and management strategies is crucial for effective treatment and improving the quality of life for those affected. If you suspect you have LP or are experiencing symptoms, consult a healthcare professional for a comprehensive evaluation and personalized care plan.
References
National Library Of Medicine PMC9442095
National Library Of Medicine PMC4819667
National Library Of Medicine PMC9065478
National Library Of Medicine PMC6344000
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