A study on the association with hepatitis B and hepatitis C in 1557 patients with lichen planus
S Birkenfeld1, J Dreiher1,2, D Weitzman3,
Lichen planus is a skin condition that causes purple or reddish-purple bumps that may be itchy. The bumps have flat tops and are uneven in shape. If you look at the bumps closely, you might see white scales or flakes on them. Lichen planus commonly affects the inner wrists, the forearms and the ankles. It may also affect the scalp, the nails, the inside of the mouth, the genitals and the anus. On the scalp, lichen planus may cause hair loss. Lichen planus of the nails can cause brittle or split nails. In the mouth, it looks like lacy white patches on the inside of the cheeks or on the tongue. Lichen planus of the mouth, genitals or anus can cause soreness and a burning sensation. Sometimes lichen planus affects areas of skin where you had a cut or burn
What causes lichen planus?
In many cases, the cause of lichen planus can't be found. It is not contagious. You can't "catch" it from or "give" it to someone else. It is not caused by stress, but sometimes stress makes it worse.
Some cases may be linked to a virus called hepatitis C. This virus can cause liver disease. Your doctor may want to order a blood test to check for hepatitis C virus. Some medicines can cause lichen planus. It is important to tell your doctor about all the medicines you are taking.
Also See : HCV Rash; Mixed Cryoglobulinemia/Photo
How will lichen planus affect me?
Lichen planus usually causes itching. The itching can be mild or very bad. You may have just a few small bumps or you may have many. The bumps may persist for weeks or months, and may return once they go away. Sometimes, after the bumps go away, they leave a dark brown area on the skin. This is more likely to happen in persons of Asian, Hispanic or African heritage. These brown spots are not scars. They will slowly fade away, but it may take many months.Lichen planus inside the mouth may cause painful sores that make it hard to eat.
How can I be sure I have lichen planus?
Only your doctor can tell if you have lichen planus. If you have any of the symptoms listed above, you should see your doctor. Your doctor may want you to have blood tests or a skin biopsy. For a biopsy, a small bit of skin is taken from one of the purple bumps. It is sent to a laboratory to see if it is lichen planus
How is lichen planus treated?
There is no cure for lichen planus, but medicine can relieve the itching and help the rash get better. If your itching is very bad, your doctor may suggest an antihistamine (one brand name: Benadryl).Most of the time, the bumps caused by lichen planus go away without any treatment after about a year. If your lichen planus is severe or if you have many bumps, your doctor may prescribe corticosteroid pills. Corticosteroid gels and ointments are used to treat lichen planus of the genitals or anus and lichen planus of the mouth if symptoms are severe. If you have lichen planus of the mouth and your symptoms are mild, you may not need any treatment. Or your doctor may recommend a mouth rinse to relieve any discomfort caused by mouth sores.
Corticosteroids have many side effects, so be sure to follow your doctor’s instructions carefully when taking these medicines.Light therapy (also called PUVA) can also be used in the treatment of lichen planus. Or, you could take a pill with a retinoid in it. Retinoids have many side effects. You have to have regular blood tests while you take this medicine.
Lichen planus of the scalp must be treated right away or the hair may never grow back.
Author: Tsu-Yi Chuang, MD, MPH, Clinical Professor, Department of Dermatology, University of Southern California; Staff Dermatologist, Desert Specialty Group, IncCoauthor(s): Laura Stitle, MD, Staff Physician, Department of Dermatology, Indiana University Medical Center
Updated: May 7, 2010
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kLichen planus on the flexor part of the wrist.
Pruritus is common in lichen planus but varies in severity depending on the type of lesion and the extent of involvement. Hypertrophic lesions are extremely pruritic.
Oral lesions may be asymptomatic or have a burning sensation, or they may even be painful if erosions are present.
In more than 50% of patients with cutaneous disease, the lesions resolve within 6 months, and 85% of cases subside within 18 months. On the other hand, oral lichen planus had been reported to have a mean duration of 5 years. Large, annular, hypertrophic lesions and mucous membrane involvement are more likely to become chronic.
In addition to the cutaneous eruption, lichen planus (LP) can involve the mucous membranes, the genitalia, the nails, and the scalp. The clinical presentation of lichen planus has several forms: actinic, annular, atrophic, erosive, follicular, hypertrophic, linear, pigmented, and vesicular/bullous. The papules are violaceous, shiny, and polygonal; varying in size from 1 mm to greater than 1 cm in diameter (see the image below). They can be discrete or arranged in groups of lines or circles. Characteristic fine, white lines, called Wickham stria, are often found on the papules (see the image below)
Close-up view of lichen planus.
Lichen planus on the oral mucosa with ulceration in the center of the lesion appears with whitish papules and plaques in the periphery.
Genital involvement is common in men with cutaneous lichen planus. Typically, an annular configuration of papules is seen on the glans. Less commonly, linear white striae, similar to the lesions on the vulva and the vagina, can be seen on male genitalia. Vulvar involvement can range from reticulate papules to severe erosions. Dyspareunia, a burning sensation, and pruritus are common. Vulvar and urethral stenosis can also be present. Two reports documented that more than 50% women with oral lichen planus had undiagnosed vulvar lichen planus.10,11 Also see the clinical guideline summary, Diagnosis and management of vulvar skin disorders.12
In 10% of lichen planus patients, ungual findings are present. Most commonly, nail plate thinning causes longitudinal grooving and ridging. Hyperpigmentation, subungual hyperkeratosis, onycholysis, and longitudinal melanonychia can result from lichen planus. Rarely, the matrix can be permanently destroyed with prominent pterygium formation. Lichen planus has been linked to childhood idiopathic nail atrophy and may overlap with twenty-nail dystrophy of childhood.
Lichen planus patients with a cutaneous eruption may also have follicular and perifollicular violaceous, scaly, pruritic papules on the scalp. These lesions can progress to atrophic cicatricial alopecia that can appear many weeks after the skin lesions have disappeared. Pseudopelade can be a final endpoint.
Variations in lichen planus include the following:
Hypertrophic lichen planus:
These extremely pruritic lesions are most often found on the extensor surfaces of the lower extremities, especially around the ankles. Hypertrophic lesions are often chronic; residual pigmentation and scarring can occur when the lesions eventually clear.
Atrophic lichen planus:
Atrophic lichen planus is characterized by a few lesions, which are often the resolution of annular or hypertrophic lesions.
Erosive/ulcerative lichen planus:
These lesions are found on the mucosal surfaces and evolve from sites of previous lichen planus involvement.
Follicular lichen planus:
Lichen planopilaris is characterized by keratotic papules that may coalesce into plaques. This condition is more common in women than in men, and ungual and erosive mucosal involvement is more likely to be present. A scarring alopecia may result.
Annular lichen planus: Lichen planus papules that are purely annular are rare. Annular lesions with an atrophic center can be found on the buccal mucosa and the male genitalia.
Linear lichen planus:
Isolated linear lesions may form a zosteriform lesion, or they may develop as a Köbner effect.
Vesicular and bullous lichen planus: Most commonly, these lesions develop on the lower limbs or in the mouth from preexisting lichen planus lesions. A rare condition, lichen planus pemphigoides, is a combination of both lichen planus and bullous pemphigoid.
Actinic lichen planus: Subtropic or actinic lichen planus occurs in regions, such as Africa, the Middle East, and India. This mildly pruritic eruption usually spares the nails, the scalp, the mucous membranes, and covered areas. Lesions are characterized by nummular patches with a hypopigmented zone surrounding a hyperpigmented center.
Lichen planus pigmentosus:
This is a rare variant of lichen planus but can be more common in persons with darker-pigmented skin, such as Latinos or Asians. It usually appears on face and neck. Some believe it is similar to or the same as erythema dyschromicum perstans (ie, ashy dermatosis).
Lichen planus pemphigoides: This is a rare form of lichen planus. Blisters subsequently develop on lichen planus lesions. Clinically, histopathologically and immunopathologically, it has features of lichen planus and bullous pemphigoid, it but carries a better prognosis than pemphigoid.