Lichen planus is an inflammatory condition typically involving the skin and characterized by severely itchy purple, polygonal, flat-topped, raised lesions that often join together to form rough scaly patches. Lichen planus also can affect your mouth, genital region, nails and scalp. Middle-aged most commonly have this condition. Although the cause of lichen planus is unknown, scientists believe it is related to overactivation of the immune system. Lichen planus may be linked to medication use and hepatitis C virus (HCV) infection. In most individuals, lichen planus spontaneously resolves after one year.
In most cases, there is no identifiable cause of lichen planus. However, drug-induced lichen planus is a possibility. The most common causes of drug-induced lichen planus include gold, thiazide diuretics, penicillamine, beta-blockers, nonsteroidal anti-inflammatory drugs, and angiotensin-converting enzyme inhibitors. Lichenoid lesions develop within a few months of beginning a medication, and lesions typically resolve after you stop taking the medication. Individuals with HCV appear to have an increased risk of developing lichen planus, with the hypothesis that long-term HCV infection triggers an immunologic response and subsequent development of lesions.
Only a physician can diagnose lichen planus. Treatment requires a prescription, and is individualized based on the severity of symptoms and lesion involvement.
For localized lichen planus on the skin, topical corticosteroids such as clobetasol, halobetasol, betamethasone, and diflorasone are recommended. Apply a thin layer of cream to the involved areas twice daily for two to three weeks. For lichen planus in the mouth, your doctor may prescribe a topical corticosteroid such as fluocinonide. Apply the ointment to your mouth six times per day, reducing the frequency of application as lesions improve. Your doctor then will assess your response to the therapy (whether lesions are resolving), and will decide whether to continue topical treatment or to proceed with alternate options. There are few side effects associated with topical treatments, but individuals may find the frequency of application cumbersome.
For generalized lichen planus of the skin, systemic corticosteroids are the most common treatment. Dose and duration of therapy vary based on the individual. The recommended dose of prednisone is 30 mg to 60 mg taken orally once daily for six weeks. Your doctor will reduce the dose over the next four to six weeks. Although systemic corticosteroids alleviate most symptoms of lichen planus, your doctor should monitor for effects on blood pressure, blood glucose and bone density. Other oral options include acitretin–the recommended dose is 30 mg taken once daily for eight weeks. Like systemic corticosteroids, acitretin has possible side effects, including problems with the liver and increased triglycerides, and you’ll need frequent monitoring.
Phototherapy (Light Therapy)
Individuals with lichen planus that is resistant to topical or oral corticosteroids may undergo psoralen plus ultraviolet A (PUVA) phototherapy. A phototherapy center administers the treatment three times per week, typically for approximately eight weeks, but duration depends on response. Note: PUVA phototherapy can increase your risk for skin cancer.