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LICHEN PLANUS

LICHEN PLANUS

What is Lichen Planus?

Lichen planus is a chronic inflammatory condition affecting the skin, hair, nails, and mucous membranes.

On the skin, it often presents as purplish, itchy, flat-topped rash developing over several weeks. In the mucous membranes, it appears as white patches which are painful.

Types of lichen planus that have similar microscopic findings are:

  • Cutaneous lichen planus
  • Mucosal lichen planus
  • Lichen planus of the nails
  • Lichen planopilaris
  • Lichen planus pigmentosus
  • Lichenoid drug eruptions

Symptoms of Lichen Planus

Cutaneous lichen planus

  • Purplish, flat-topped rash.
  • The rash has to cross white lines over it.
  • Size ranges from pin point to larger than a centimeter.
  • The rash can be scattered, linear, clustered, or only on sun-exposed areas.
  • On palms and soles, the rash appears yellowish brown.
  • The rash goes off after some months and leaves a grayish-brown mark on the skin that fades after a year or two.

Oral lichen planus

  • Involves the inside of cheeks, sides of tongue, gums, and lips.
  • Painless white lines.
  • Painful and persistent ulcers.
  • Redness and peeling of gums.

 Vulval lichen planus

  • Affects the female private parts and area around it.
  • Painless white lines
  • Painful and persistent ulcers.
  • Scarring resulting in lump formation, causing narrowing of the vaginal passage.
  • Inflammation of vaginal lining preventing intercourse and causing white or bloody discharge from the vagina.

Other mucosal sites

Uncommonly erosive lichen planus can be seen in the eyelids, external ear canal, oesophagus, larynx, bladder and anus.

Lichen planopilaris

Tiny red eruptions are seen on the scalp. Destruction of the hair follicles leads to permanent bald patches on the scalp.

Nail lichen planus

  • Thinning of the nail plate which may be grooved and ridged.
  • Darkening and separation of the nail from the nail bed (onycholysis).
  • Destruction of cuticle which forms a scar (pterygium).
  • Complete stoppage of nail growth and its disappearance (anonychia).

Lichen planus pigmentosus

Ill-defined oval, grayish-brown marks on the face, neck, trunk, limbs or in the armpits without an inflammation.

It has a diffuse pattern.

Causes of Lichen Planus

Lichen planus is a T-cell mediated autoimmune disease.

Triggering factors for lichen planus can be:

  • Family history of lichen planus
  • Physical and emotional stress
  • Hepatitis C infection
  • Herpes zoster infection
  • Injured places on the skin (koebner’s phenomenon).
  • Certain chemicals
  • Medications like anti hypertensive drugs, drugs for arthritis and heart diseases.

Diagnosis of Lichen Planus

  • Skin biopsy
  • A part of the affected skin is cut and sent to a laboratory for examination.
  • Patch test
  • To identify the agent to which the patient is allergic and that may have triggered the disease.
  • Hepatitis C test
  • To check if Hepatitis C virus has triggered the disease in the patient.

Self help

Cutaneous lichen planus

  • Use of plain warm water for washing the affected areas.
  • Do not use too much of soaps to wash the affected skin.
  • Use of moisturizers to avoid the skin dryness.

Oral lichen planus

  • Avoid eating spicy foods or foods with acidic contents like fruit juices as they can irritate the oral lichen planus.
  • Eat more of soft and bland foods such as mashed potatoes.
  • Avoid the use of alcohol and mouthwashes that contain alcohol.

Vaginal lichen planus

  • Avoid the use of soaps for washing. Instead, wash the area using plain warm water.
  • Use of moisturizers before and after urinating every time.
  • Use of loose, cotton garments and avoiding tight clothes.

 Homoeopathic Management

Sulphur

  • skin eruptions with marked itching and burning
  • < warmth
  • < evening
  • There is history of suppression of eruption with local application

Arsenic

  • Ulcers and eruptions which are popular in nature with marked itching.
  • Burning and cutting pain violent in nature
  • Restlessness and Anxiety Present along with the symptoms

Sulphur Iod

  • Eruptions which are popular in nature are present on the arms and face.
  • Accompanied by itching

Kali Iod

  • Papular eruptions purplish in nature are located on the legs.
  • Itching < night, heat
  • Iching> scratching

Apis Mellifica

  • Papular eruptions with intense stinging and burning pain.
  • Intolerable itching and Burning and it is worsened by heat.
  • > cold in general

Merc Sol

  • Given for oral lichen planus
  • Ulcers present on tongue, gums and oral mucosa with undefined irregular edges.
  • Profuse salivation with metallic taste in the mouth
  • Increased thirst

Borax

  • For oral Lichen Planus
  • White patchy growths or ulcers are present in the mouth
  • Oversensitiveness to pain and touch
  • Bitter taste in mouth

Plantago

  • For oral Lichen Planus
  • White patches are present on the tongue
  • Offensive Breath and Putrid Taste in the mouth