April 15, 2024

Lichen Planus: Top Pathologist Explains Treatment & Management

Written by our expert


Dr. Neha Singh

Master's in Pathology (DNB) & MBBS

Lichen Planus: Top Pathologist Explains Treatment & Management
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What Is Lichen Planus?

Lichen planus is a chronic inflammatory condition affecting the skin, mucous membranes, hair, and nails. It typically presents as itchy, reddish-purple bumps or lesions that may be flat-topped and shiny.

The exact cause of lichen planus is poorly understood, but it is believed to involve an abnormal immune response.

Lichen planus can occur on various parts of the body, including:

  • Skin: The most common presentation is on the skin, where it often appears as small, flat-topped, polygonal bumps that may be itchy. These lesions can develop anywhere on the body but often occur on the wrists, ankles, lower back, and genital area.
  • Mucous membranes: Lichen planus can also affect the mucous membranes lining the mouth, genitals, esophagus, and other areas. Oral lichen planus typically presents as white, lacy patches or sores inside the mouth, while genital lichen planus can cause similar lesions on the genital skin.
  • Hair and nails: In some cases, lichen planus can affect the scalp, leading to hair loss and scarring (a condition called lichen planopilaris). It can also affect the nails, causing ridges, grooves, and discoloration.
What is lichen planus
Understanding Lichen Planus Source

Lichen Planus is not an isolated entity but a part of lichenoid disorders.

Lichenoid disorder is a term used to describe a group of skin conditions that share similarities with lichen planus, either in their clinical appearance or histopathological features.

These disorders may resemble lichen planus in terms of their appearance under microscopic examination or in how they manifest on the skin. Some common lichenoid disorders include:

  • Lichen Planus: As mentioned earlier, lichen planus is a chronic inflammatory condition characterized by the development of itchy, reddish-purple bumps or lesions that are flat-topped and shiny. It can affect the skin, mucous membranes, hair, and nails.
  • Lichen Planus Pigmentosus (LPP): LPP is a subtype of lichen planus that primarily affects individuals with dark-colored skin. It leads to the development of dark brown to grayish-blue patches on the skin, particularly in sun-exposed areas.
  • Lichenoid Drug Eruptions: Some medications can induce a lichenoid eruption, which resembles lichen planus clinically and histopathologically. These eruptions can occur as a reaction to various drugs, including certain antibiotics, antihypertensives, and nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Graft-versus-Host Disease (GVHD): GVHD is a complication that can occur after allogeneic stem cell transplantation, where the donor's immune cells attack the recipient's tissues. Cutaneous GVHD can present with lichenoid features, including erythematous papules and plaques.
  • Erosive Lichen Planus: This variant of lichen planus involves erosions and ulcers on mucosal surfaces, particularly in the oral cavity and genital area. It can be painful and may require specific management.
  • Lichenoid Dermatitis: This term is used to describe various skin conditions that clinically or histopathologically resemble lichen planus. Examples include lichenoid drug eruptions, lichenoid interface dermatitis, and lichenoid tissue reactions to certain infections or allergens.
Lichen Planus Pigmentosus Starts With Lesions On Face
Lichen planus pigmentations Source

Diagnosis of lichenoid disorders typically involves a combination of clinical evaluation, histopathological examination of skin biopsy specimens, and consideration of potential triggers such as medications or underlying systemic diseases.

What is Lichen Planus Pigmentosus?

Lichen Planus Pigmentosus (LPP) is a subtype of lichen planus that primarily affects individuals of skin color, particularly those of Indian, Middle Eastern, and Latin American descent. It is characterized by the development of dark brown to grayish-blue patches on the skin, typically in sun-exposed areas such as the face, neck, and flexural areas (skin folds).

Unlike typical LP lesions, LPP lesions lack the classical shiny and reddish-purple appearance. LPP lesions may or may not be associated with itching. The exact cause of LPP is not fully understood, but it is believed to involve genetics, environmental factors, and possibly sun exposure.

Is Lichen Planus Contagious?

Lichen planus, including lichen planus pigmentosus, is not contagious. It is an inflammatory condition of the skin and mucous membranes that arises from an abnormal immune response, not from a contagious pathogen like a virus or bacteria.

It cannot be transmitted from person to person through contact, including skin-to-skin contact.

Is Lichen Planus Curable?

Lichen planus is typically considered a chronic condition, meaning no permanent cure exists. However, the symptoms of lichen planus can often be managed effectively with appropriate treatment, and the condition may go into remission for periods.

Treatment for lichen planus aims to alleviate symptoms such as itching, discomfort, and cosmetic concerns associated with skin lesions.

The choice of treatment depends on the type and severity of lichen planus and may include:

  • Topical Corticosteroids: These medications can help reduce inflammation and itching associated with lichen planus lesions. They are often the first-line treatment for mild to moderate cases.
  • Topical Calcineurin Inhibitors: Drugs like tacrolimus or pimecrolimus may be used as corticosteroid alternatives, particularly for sensitive areas such as the face, genitals, or mucous membranes.
  • Oral Corticosteroids: In cases of severe or widespread lichen planus, oral corticosteroids may be prescribed briefly to control inflammation and symptoms. However, long-term use is generally avoided due to the risk of side effects.
  • Topical Retinoids: Retinoids may help reduce inflammation and promote normalizing skin cell growth. They are sometimes used in combination with other treatments for lichen planus.
  • Phototherapy: Narrowband ultraviolet B (UVB) phototherapy or PUVA (psoralen plus ultraviolet A) therapy may be beneficial in some cases of lichen planus, particularly for widespread or recalcitrant lesions.
  • Immunosuppressive Medications: Drugs such as methotrexate, cyclosporine, or mycophenolate mofetil may be prescribed for severe cases of lichen planus that do not respond to other treatments.

While these treatments can help manage symptoms and improve quality of life, lichen planus may recur or flare up periodically even after successful treatment. Additionally, some individuals may experience persistent symptoms despite treatment. Regular follow-up with a dermatologist is important for monitoring the condition and adjusting treatment as needed.

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Can Lichen Planus Pigmentation Be Removed?

The pigmentation associated with lichen planus pigmentosus (LPP) can be challenging to treat, and complete removal may not always be possible. However, various treatment options can help reduce the appearance of pigmentation and improve the overall skin condition.

It's important to note that individual responses to treatment can vary, and what works for one person may not be as effective for another.

Some treatment options that may be considered for reducing pigmentation associated with LPP include:

Topical Treatments: Medications such as corticosteroids, calcineurin inhibitors (e.g., tacrolimus), or retinoids may help lighten pigmentation and reduce inflammation in the affected areas. These medications are often applied directly to the skin and can be effective, particularly for mild cases of LPP.

Chemical Peels: Chemical peels containing glycolic or salicylic acid ingredients may help exfoliate the skin and reduce pigmentation. These peels remove the outer layers of skin, leading to a more even tone and texture.

Laser Therapy: Various laser treatments, such as fractional laser therapy or Q-switched laser therapy, may target and lighten pigmented areas of the skin. Laser therapy breaks down melanin pigment in the skin, leading to a more uniform complexion. Multiple sessions may be needed for optimal results.

Microneedling: Microneedling involves using a device with fine needles to create tiny punctures in the skin, stimulating collagen production and improving skin texture. Microneedling combined with topical medications or serums may help reduce pigmentation associated with LPP.

Sun Protection: Protecting the skin from sun exposure is crucial for preventing further darkening of pigmented areas. Sunscreen with a high SPF should be applied daily, and protective clothing should be worn when outdoors.

It's essential to consult with a dermatologist or skin care specialist to determine the most appropriate treatment approach for LPP pigmentation.

They can assess the severity of the pigmentation, discuss available treatment options, and tailor a treatment plan based on individual needs and preferences.

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