Definition

Lichen planus is a skin condition of unknown origin that produces small, shiny, flat-topped, itchy pink or purple raised spots on the wrists, forearms or lower legs, especially in middle-aged patients.

  Description

Lichen planus affects between 1-2% of the population, most of whom are middle-aged women. The condition is less common in the very young and the very old. The lesions are found on the skin, genitals, and in the mouth. Most cases resolve spontaneously within two years. Lichen planus is found throughout the world and is equally distributed among races.

  Causes and symptoms

No one knows what causes lichen planus, although some experts suspect that it is an abnormal immune reaction following a viral infection, probably aggravated by stress. The condition is similar to symptoms caused by exposure to arsenic, bismuth, gold, or developers used in color photography. Occasionally, lichen planus in the mouth appears to be an allergic reaction to medications, filling material, dental hygiene products, chewing gum or candy.

Symptoms can appear suddenly, or they may gradually develop, usually on the arms or legs. The lesions on the skin may be preceded by a dryness and metallic taste or burning in the mouth.

Once the lesions appear, they change over time into flat, glistening, purple lesions marked with white lines or spots. Mild to severe itching is common. White, lacy lesions are usually painless, but eroded lesions often burn and can be painful. As the lesions clear up, they usually leave a brown discoloration behind, especially in dark skinned people.

Lichen planus in the mouth occurs in six different forms with a variety of symptoms, appearing as lacy-white streaks, white plaques, or eroded ulcers. Often the gums are affected, so that the surface of the gum peels off, leaving the gums red and raw.

  Diagnosis

A doctor can probably diagnose the condition simply from looking at the characteristic lesions, but a skin biopsy may be needed to confirm the diagnosis.

  Treatment

Treatment is aimed at easing symptoms. Itching can be treated with steroid creams and oral antihistamines. Severe lesions can be treated with corticosteroids by mouth, or combinations of photochemotherapy (PUVA) and griseofulvin.

Patients with lesions in the mouth may find that regular professional cleaning of the teeth and conscientious dental care improve the condition. Using milder toothpastes instead of tartar control products also seems to lessen the number of ulcers and makes them less sensitive.

  Prognosis

While lichen planus can be annoying, it is usually fairly benign and clears up on its own. It may take months to reach its peak, but it usually clears up within 18 months.

   Key Terms:

PUVA A type of phototherapy that combines the oral or topical photosensitizing chemical psoralen, plus long-wave ultraviolet light-A (UVA).

   Resources:

Books

• Manual of Clinical Problems in Dermatology. Ed. Susan M. Olbricht, et al. Boston: Little, Brown and Co.,1992.

Periodicals

• Burkhart, N. W., E. J. Burkes, and E. J. Burker. "Meeting the Educational Needs of Patients with Oral Lichen Planus." General Dentistry 45 (1997): 126-132.

Other

• Lichen Planus Self-Help. Baylor College of Dentistry. http://www.tambcd.edu/lichen