Lichen Planus
What is lichen planus?
Lichen planus is a recurrent rash that is due to inflammation. The
rash is characterized by small, flat-topped, many-sided (polygonal)
bumps that can grow together into rough, scaly patches on
the skin. There may also be a rash in the lining (mucous membranes)
of the mouth or vagina.
Lichen planus is a very curious skin condition, the effects of which are
localized to the areas of involvement. (Lichen refers to a tree moss while planus is Latin for
flat = like a flat tree moss.)
How is the rash of lichen planus different from that of most
other common rashes?
The major point of distinction of lichen planus from eczema,
psoriasis, and other common rashes is its color -- lilac or violet.
The textbooks call it "violaceous."
What are the symptoms of lichen planus?
Lichen planus itches with an intensity that varies in different
people from mild to severe.
The onset of lichen planus can be sudden or gradual. The first
attack may last for weeks or months, and recurrences may happen for
years. Children are not often affected by lichen planus. The bumps
at first are 2 to 4 mm in diameter, with angular borders, and a
violaceous color. At the onset of the disease, new bumps may appear
at sites of minor skin injury, such as a superficial scratch. An
excess of pigment (hyperpigmentation) may develop in the affected
skin as the lesions persist. Rarely, a patchy scarring balding
(alopecia) of the scalp occurs.
What does lichen planus look like?
The appearance of lichen planus depends on whether the skin or the
lining (mucous membranes) inside the mouth or vagina are affected:
- Skin involvement: The usual skin involvement with lichen
planus consists of flat-topped lilac or violet spots a few
millimeters in diameter on the skin. These spots tend to be located
on the inner wrists, forearms, the lower legs just above the ankles,
and the lower part of the back.
A variant of this disease is called hypertrophic lichen
planus. This condition appears as thick, reddish-brown lesions
that are covered with scales. These spots tend to be on the shins,
but they can occur anywhere on the body. This is an especially itchy
and persistent (chronic) variant of lichen planus.
- Mucous membranes: Lichen planus of the mucous membranes is common.
Dentists often come across it as a white, lacy rash on the inside of the
cheeks of people who are unaware of the condition. About half of the people
affected with lichen planus have the rash inside of their mouths (oral
mucosa). The oral rash often occurs prior to any skin involvement.
More troublesome, although rare, is erosive lichen planus,
which can be quite sore and uncomfortable. This erosive form
typically causes the patient to complain of the shallow and often
quite painful, recurrent ulcers in the mouth.
Lichen planus can affect the female genitals, including the
vagina. This condition can be confused with sexually transmitted
diseases (STDs), although lichen planus is neither sexually
transmitted nor contagious.
Sometimes, lichen planus produces pits and grooves in the nails as
well.
Next: How is lichen planus diagnosed? »
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