Lichen planus is an inflammatory condition that affects the skin and mucous membranes. It can result in an itchy, non-infectious rash and can affect many parts of the body, including your trunk, arms, legs, scalp, nails, genitals, and mouth – when it affects the mouth, it is known as oral lichen planus. The symptoms of this disease vary slightly depending on the area that’s affected.
- Skin: reddish-purple, raised, flat, shiny papules or bumps
- Ankles: Scaly, thick patches around the ankles
- Nails: ridged, grooved, and thinner or thicker, darker, or raised.
- Mouth: white and red patches, a white pattern on the inner cheeks and tongue, painful gums, and a burning or discomfort while eating or drinking
- Genital organs: white or purple ring-shaped patches, bumps, and a rash that doesn’t itch on the penis; white, red, or pink streaks and red patches in the vulva. You may also get a green or yellow discharge and experience a burning sensation and soreness around your vulva.1
It is estimated that around 1% to 2% people in the world have this condition. However, it is not known what exactly causes it. Here are some factors that researchers feel might be at play.
1. Autoimmune Response
Your immune system protects you from infection and disease by producing proteins known as antibodies which attack harmful viruses and bacteria. The immune system tends to be overactive in people who have lichen planus, producing excessive antibodies which cause the skin to become inflamed. This abnormal immune response is known as an autoimmune response and may be responsible for the symptoms experienced by people with lichen planus.2
2. Reaction To Certain Medication
Lichen planus may also develop due to a reaction to some medicines. Medications used to treat heart disease, arthritis, high blood pressure, malaria, and diabetes, as well as non-steroidal anti-inflammatory painkillers and certain antibiotics, may be to blame. If this is the case, your rashes should clear up when you stop taking the concerned medicine. However, please do not stop any medicine that you’ve been prescribed without checking with your doctor.3
3. Reaction To Metal Fillings In The Mouth
Though it’s rare, sometimes, metal fillings in the mouth have been known to cause oral lichen planus. More likely in women than men, and mostly caused in the middle ages, lichen planus can occur after you have got an amalgam dental filling. About 50% of amalgam dental fillings is made of mercury, and the mercury can cause a reaction.4 5 If this is so, substituting a non-metal filling for the metal filling will clear your lichen planus.
4. Family History Of Lichen Planus
A rare kind of lichen planus called familial bullous lichen planus is known to run in families. However, do keep in mind that other kinds of lichen planus do not appear to be hereditary.6
One study found that the shin is most commonly affected in familial bullous lichen planus, after which come the upper limbs and thighs. This kind of lichen planus tends to be chronic and progressive. It also usually doesn’t involve the torso and the mouth.7
5. Hepatitis C Infection
If you have lichen planus, to be on the safe side, do a test for hepatitis C.
Some experts feel that there could be a link between a hepatitis C, an inflammation of the liver caused by the hepatitis C virus, and lichen planus. Many people who have hepatitis C also suffer from lichen planus. It is even suggested that people with lichen planus should be tested for hepatitis C. Since a hepatitis C infection is difficult to diagnose because it generally doesn’t show symptoms until too late, lichen planus could help the patients get an earlier diagnosis and treatment.8 9 10
6. Other Viral Infections
Some cases of oral lichen planus have also been associated with viral infections like those caused by Epstein-Barr virus, cytomegalovirus, varicella zoster virus, human herpes virus, human papilloma virus, and human immunodeficiency virus (HIV), though not as commonly as with hepatitis C.11
Though you may not be aware of this connection, skin and mental health are closely related. While there’s debate about whether lichen planus is caused by stress, it is established that emotional stress can worsen this condition in some cases.12 Studies have found that patients tend to have higher levels of depression and anxiety, which further worsens the condition.13 Psychiatric counseling may also be required to improve the quality of life.
What Can You Do About It?
There is no specific treatment that can cure lichen planus. However, most cases resolve on their own within a period of 6 to 9 months. In the meantime, some home remedies like turmeric and aloe vera can help you deal with its symptoms. Get some sunlight and eat foods rich in vitamin A and folate. Some patients have been found to be deficient in folate and vitamin D.14 15 Your doctor may also recommend steroid ointments to ease itching and check the rash.16
|↑1||Lichen planus – Symptoms. National Health Service.|
|↑2||Causes of lichen planus. National Health Service.|
|↑3, ↑12||Lichen Planus. American Skin Association.|
|↑4||Sugerman, P. B., N. W. Savage, L. J. Walsh, Z. Z. Zhao, X. J. Zhou, A. Khan, G. J. Seymour, and M. Bigby. “The pathogenesis of oral lichen planus.” Critical Reviews in Oral Biology & Medicine 13, no. 4 (2002): 350-365.|
|↑5||Laeijendecker, Ronald, Sybren K. Dekker, Piet M. Burger, Paul GH Mulder, Theodoor Van Joost, and Martino HA Neumann. “Oral lichen planus and allergy to dental amalgam restorations.” Archives of dermatology 140, no. 12 (2004): 1434-1438.|
|↑6, ↑10||Lichen planus: Who gets and causes. American Academy of Dermatology.|
|↑7||Huang, Changzheng, Siyuan Chen, Zhixiang Liu, Juan Tao, Chunsen Wang, and Youwen Zhou. “Familial bullous lichen planus (FBLP): Pedigree analysis and clinical characteristics.” Journal of cutaneous medicine and surgery 9, no. 5 (2005): 217.|
|↑8, ↑11||Nima, Mahboobi, and Hosseini FarzanehAgha. “Hepatitis C virus and lichen planus: the real association.” Hepatitis monthly 2010, no. 3, Summer (2010): 161-164.|
|↑9||Hepatitis C. National Institutes of Health.|
|↑13||Sandhu, Simarpreet V., Jagpreet S. Sandhu, Himanta Bansal, and Vinay Dua. “Oral lichen planus and stress: An appraisal.” Contemporary clinical dentistry 5, no. 3 (2014): 352.|
|↑14||Thongprasom, Kobkan, Pornpan Youngnak, and Vilaiwan Aneksuk. “Folate and vitamin B12 levels in patients with oral lichen planus, stomatitis or glossitis.” (2001).|
|↑15||Thum-Tyzo, Karolina, Beata Petkowicz, Bartłomiej Tyzo, Marlena Pedowska, and Marcin Dziedzic. “OI0378 Vitamin D3 and oral health in patients with lichen planus.” Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 117, no. 5 (2014): e385.|
|↑16||Lichen planus. National Health Service.|