Lichen Planus (cont.)
Gary W. Cole, MD, FAAD
Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Lichen planus facts
- What is lichen planus?
- What causes lichen planus?
- How is the rash of lichen planus different from that of most other common rashes?
- What are the symptoms and signs of lichen planus?
- What does lichen planus look like?
- How is lichen planus diagnosed?
- What is the treatment for lichen planus?
- What is the long-term prognosis of lichen planus?
- Find a local Dermatologist in your town
How is lichen planus diagnosed?
Usually, lichen planus is relatively straightforward to diagnose. Physicians can make the diagnosis in typical cases simply by looking at the rash. If necessary, a skin biopsy may be done to help confirm the diagnosis because, under the microscope, lichen planus is distinctive in appearance.
Because there are a number of other lichenoid eruptions that to resemble lichen planus a biopsy confirmation is frequently necessary. Persistent oral or vaginal lichen planus, with spots that thicken and grow together, can sometimes be difficult to distinguish clinically from whitish precancerous plaques called leukoplakia. A biopsy can be helpful in this situation. There seems to be a few patients in whom ulcerative lichen planus precedes the development of oral cancer.
What is the treatment for lichen planus?
Most cases of lichen planus are relatively mild. Affected individuals who do not have symptoms do not need treatment. Ultimately, there is no agreed upon cure for this condition.
If the itch or appearance of the rash are unpleasant, topical corticosteroid creams may be of help. Topical steroid creams that, for example, are under wrapping or taped at bedtime may also be useful when possible. For localized, itchy, thick lesions, injections of corticosteroids may be given. Antihistamines may blunt the itch, particularly if it is only moderate. This effect is in part due to the sedative effect of antihistamines.
In more severe cases, physicians may recommend oral medications or therapy with ultraviolet light. Oral medications may include a course of oral corticosteroids such as prednisone or metronidazole (Flagyl). Occasionally, other immunosuppressive agents may be employed. However, the itching may return after the drug has been discontinued. A low-dose oral corticosteroid every other morning may be also prescribed. With continued itching, ultraviolet light (PUVA) treatment may help. For painful lesions within the mouth, the use of special mouthwashes containing a painkiller (such as lidocaine) before meals may provide some relief. Any drug or chemical suspected of being the cause of the lichen planus should be discontinued.
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