Lichen planus is a condition on the skin that is considered as an inflammatory, autoimmune, and mucocutaneous disease. Also, some experts describe it as a dermatosis and a papulosquamous disease. In terms of appearance, it looks the same as lichen, which is a composite organism that consists of a photobiont (like green algae or cyanobacterium) and a fungus. To the naked human eye, it is like a small lesion that is pinkish or purplish, flat-topped, and shiny. Lichen planus can be found on the lower legs, forearms, or wrists of a patient. On the other hand, some of the patients who were found out to be infected even have lesions on their mouths and genitalia.
Lichen planus is not contagious. However, anyone suffering from this disease must be constantly observed, especially if he or she has lesions in the mouth. If the lesions in the mouth are ignored, it is possible for the condition to develop into mouth cancer.
As of the time of writing, this disease has infected only about 1% to 2% of the population. Its sufferers are mostly middle-aged people; children and old people are less likely to suffer from lichen planus. Middle-aged women comprise the majority of sufferers.
Anyone can suffer from this disease regardless of race. According to statistics, most patients who suffered from this recovered from it after two years of being infected. Nonetheless, it is an irritating and somewhat debilitating condition.
As of the time of writing, experts have not yet found out the exact reasons for this disease and its development. However, specialists have already come up with a list of causes, and the most likely culprit is an autoimmune trigger after a viral infection. Additionally, experts have pinpointed that stress plays a huge role in the development of this disease.
Specialists have proven that lichen planus does not have any pathogens involved. Also, according to them, some of the following may trigger a lichenoid reaction which is connected to lichen planus.
- Hepatitis, which includes primary biliary cirrhosis and hepatitis B and C infection
- Adverse body reaction against metal alloy (amalgam) fillings
- Lesions caused by graft versus host disease
- Drug reactions which include penicillamine, metformin, spironolactone, furosemide, thiazide diuretics, antimaliarials, beta blockers, and gold salts
The symptoms of lichen planus are a bit similar to the effects of overexposure to materials used in color photography such as developers, gold, bismuth, and arsenic. When lichen planus infects the mouth, it is often mistaken for allergic reactions to certain candy, chewing gums, dental hygiene products, filling material, or medications.
The symptoms of lichen planus have the tendency to appear instantly, though in some cases, they may surface gradually, especially if the lesions appear on the patient’s arms or legs. Once the lesions become apparent, the patient may experience burning sensations, dryness, and a “metallic” taste in the mouth.
The lesions will gradually become flat and glistening, and then they will become purplish with white spots or lines. The patient may experience mild to severe itching sensations. Alternately, if the lesion is whitish and lacy, it might be not as itchy and painful as a purple lesion. However, if the lesion becomes eroded, one must expect that it will be painful and will often cause a burning sensation.
If the lesions occurred in the mouth of the patient, they may undergo six different forms. Typically, the lesions in the mouth may appear as eroded ulcers, white plaques, or lacy white streaks. Also, the gums will be affected by these lesions. Lesions may make the patient’s gums peel off, thus exposing raw and red gums.
Lichen planus can be categorized according to the location of its lesions. The two categories are:
A lesion can be considered cutaneous if it appears in the nails, scalp, or skin. This category is the most common lichen planus occurrence that is diagnosed by doctors. This is also the one that people can easily identify.
Mucosal lichen planus can also occur in the gastrointestinal tract which includes the anus, stomach, esophagus, pharynx, and mouth. Also, mucosal lesions also appear in the larynx, genitals, ears, nose, bladder, peritoneum, and in the conjunctiva of the eyes. Sometimes, lichem planus is also called oral mucosal lichen planus, though this is placed in a different category by itself.
Lichen planus lesions also form patterns. Those patterns are:
- Annular: This lesion pattern appears like rings or connected circular groups of clear papules. The center of these lesions are usually unaffected by the lichen planus. Roughly 10% of lichen planus cases have annular patterns.
- Linear: As its name suggests, the lesions form a line. It is also usually called the Blaschko line lesion type. This type rarely develops on the patient’s face.
- Hypertrophic: This pattern usually presents itself on a person’s extremities, especially on the interphalangeal points and shins. Also, hypertrophic lesions are typically the itchiest type of lichen planus.
- Atrophic: It has bluish white papules or some plaques with atrophy. This lesion type is rare.
- Bullous: This lesion pattern is another rare type of lichen planus. The lesions of this type commonly develop bullae and vesicles.
- Ulcerative: Its main characteristics are ulcerations on the feet and chronic and painful bullae. It usually has evident cicatricial sequelae. This is another rare variant of the disease.
- Pigmented: The pigmented type has obvious dark brown macules—which are hyper pigmented—in body folds and areas that are usually exposed to the sun. This is another rare type.
A doctor only needs to see the lesions for him to be able to declare if those are caused by lichen planus. However, he or she might sometimes need to conduct a biopsy to come up with a more conclusive diagnosis and thus prescribe the appropriate treatment.
- Oral candidiasis
- Oral leukoplakia
- Chronic cheek biting (Morsicatio buccarum) and frictional keratosis
- Chronic ulcerative stomatitis
- Lupus erythematosus
- Benign mucous membrane pemphigoid
- Pemphigus vulgaris
The treatment of this disease is usually aimed at easing the symptoms. The treatment includes oral antihistamines and steroid creams for relieving the itching sensations brought about by the lesions. In case the lesions are severe, some doctors may prescribe oral corticosteroids or combinations of griseofulvin and photochemotheraphy (PUVA).
On the other hand, those suffering from lichen planus in the mouth can find comfort in professional dental cleaning. Also, using milder toothpaste instead of the ones that control tartar can inhibit the proliferation of ulcers as well as lessen the lesions’ sensitivity.
Lichen planus will disappear by itself after at least 18 months. Although this condition is considered benign, it can annoy you very much, especially if you do not address it right away.
A few words of caution: never attempt to conduct a diagnosis on yourself. In case you feel that you might be infected by this disease, you should immediately consult your doctor for sound medical advice. Even though the condition will completely disappear by itself, it is still important that you seek professional medical help for it to be cured. Be reminded of the possibility of this disease forming cancer cells.