Article by Dr Manasa S, B.A.M.S
Lichen planus is a power inflammatory situation that impacts the pores and skin, nails, oral mucosa, scalp, arms, legs, and genital areas. Often called lichenoid dermatitis amongst healthcare professionals, this situation manifests as purple, itchy, flat elevated lesions on the pores and skin, usually creating over a number of weeks. These lesions may be notably bothersome on account of their look and the extreme itching they trigger.
Within the mouth and genital areas, lichen planus usually presents as lacy white patches, which might typically be accompanied by painful sores. Though it will probably have an effect on anybody, the situation is mostly seen in middle-aged adults and is understood for its unpredictable course, the place signs might resolve inside months however have the potential to recur.
Early recognition and acceptable administration might help alleviate signs and forestall issues, making a complete information of this situation useful for efficient therapy and affected person care.
Causes of lichen planus
The reason for lichen planus remains to be not utterly understood, however the immunity part shouldn’t be dominated out. It’s mostly understood as associated to the immune system attacking cells of the pores and skin or mucous membrane. Some analysis says that lichen planus shouldn’t be an autoimmune situation, however the responses resemble immunity problems. It’s an idiopathic situation the place the causes of the ailments are unknown.
In a wholesome particular person, T cells of the immune system carry out the perform of defending the physique from infections. Nonetheless, in individuals affected by lichen planus, their immune system’s T cells assault a protein of their pores and skin and mucous membrane. It’s not clear what makes the T cells assault the protein.
The principle causes may be outlined as beneath:
– Allergens
– Viral infections
– Stress
– Genetics
– In few circumstances, lichen planus happens together with the autoimmune problems
Indicators and Signs of lichen planus
The overall signs of lichen planus rely on which a part of the physique it impacts. Signs are as under –
– Purple, shiny, raised bumps often on the interior forearms, wrists or ankles
– Lacy white patches on the tongue or inside cheeks
– Average to extreme itching
– Sores within the mouth and genitals are sometimes painful
– Hair loss, although uncommon
– Darkish traces from the tip of the nail to the bottom
– Nail scarring or loss
Detailed description of signs in keeping with physique components it impacts
Pores and skin: The most typical signs are purple or purple raised pores and skin lesions also known as bumps. These bumps are agency and will itch loads or little. They might be few in quantity to a number of them and could also be related to white traces or scales. They’ll happen wherever, however are commonest on wrists, arms, and ankles. These bumps typically seem within the locations on the pores and skin the place the pores and skin has already been burned or scratched.
Mouth: Lichen planus within the oral cavity seems like a lacy patch of white tiny dots. These patches could also be discovered on the tongue additionally. In delicate circumstances, they could not trigger any signs in any respect or few signs, however in extreme situations, they trigger redness and soreness.
Nails: Lichen planus might seem on a number of, or the entire fingernails and toenails. Thinning, ridge forming, splitting and nail loss are the indicators of this situation.
Scalp: Tiny bumps, redness, and irritation may be seen on the scalp. In sure circumstances, hair thinning and hair loss can also be noticed.
Genitals: Redness and soreness are the primary indicators of genital lichen planus.
Sample of presentation famous generally in lichen planus affected person historical past
Lesions initially develop on the flexural surfaces of the limbs, with a generalized eruption sample creating after per week or extra and in depth spreading inside 2 to six months.
Itching of various severity, relying on the kind of lesion and the extent of involvement.
Oral lichen planus could also be asymptomatic, burning, redness and even painful.
The lesions that happen on the pores and skin surfaces sometimes resolve inside 6 months. That is seen in 50% and 18 months in round 18% of circumstances.
Persistent lesions are extra doubtless oral lichen planus or with massive annular hypertrophic lesions and mucous membrane involvement.
Sure variations of medical presentation
– Atrophic lichen planus
– Hypertrophic lichen planus
– Ulcerative or erosive lichen planus
– Annular lichen planus
– Linear lichen planus
– Follicular lichen planus
– Vesicular lichen planus
– Bullous lichen planus
– Actinic lichen planus
– Lichen planus pemphigoides
– Lichen planus pigmentosus
Sure triggering elements have been recognized that are as talked about under
– Hepatitis C an infection
– An allergic response to the steel in dental fillings
– Latest analysis which is printed within the yr 2021 says that sure elements level to genetic susceptibility. Due to this fact, now it’s understood that lichen planus can run within the households.
– Painkillers and sure different medicines
– Vaccines
– Explicit chemical compounds, metals or pigments
– Sure medicines used to deal with arthritis, coronary heart illness or hypertension.
Threat elements
Anybody can get affected with lichen planus, however it most frequently impacts center aged adults. Lichen planus within the mouth impacts girls greater than males. Some research counsel that girls may get lichen planus twice as usually as males, and they’re extra more likely to develop it of their 60s. Males usually tend to develop of their 40s.
Problems
Lichen planus may be tough to deal with if it impacts the vulva, vagina inflicting scarring related to extreme ache. Sores on the genitals are extraordinarily painful and make intercourse painful.
Sores within the oral mucosa make it tough to eat meals. Oral lichen planus might improve the danger of oral most cancers.
Lichen planus if impacts the ear, it might result in listening to loss.
Lichen planus of pores and skin and nails even after the therapy may keep as barely darker patches.
Osteoporosis, an infection, adrenal insufficiency, bone marrow suppression, renal injury, hyperlipidemia, and progress restriction in youngsters might happen on account of antagonistic results of medicine.
Residual hyperpigmentation after the irritation could also be a typical signal after lichen planus has subsided.
Alopecia related to lichen planus is many of the instances everlasting
Epidemiology
There isn’t a vital geographical variation in frequency famous for lichen planus.
United states of america: It’s reported in roughly 1% of all new sufferers seen at healthcare clinics. Some components of the USA reported to have noticed greater prevalence in December and January.
Race: No racial predisposition has been reported for lichen planus.
Intercourse: No vital distinction in incidence for lichen planus are famous between female and male sufferers, however girls usually tend to endure from lichen planus.
Age: Greater than two third of lichen planus sufferers are aged between 30-60 years; nevertheless, it will probably happen at any age.
Incidence of lichen planus
Roughly 0.22% to 1 % of the grownup inhabitants is affected. The incidence of oral lichen planus worldwide is 1% to 4 %.
Widespread diagnostic standards of lichen planus
It’s sometimes identified after the evaluation of signs and bodily examination. Lichen planus has some particular characters that are identified by the time period “six Ps” that assist to diagnose the situation are:
– P1 – Pruritic [The itchy skin lesions]
– P2 – Purple lesions [bumps]
– P3 – Plaques [raised, discolored, patches]
– P4 – Polygonal [sharp angled rash]
– P5 – Planar [ top is flat]
– P6 – Papules
Additional analysis is completed with the assistance of the next investigations –
– Allergy check: An allergy check completed can decide if allergy is the explanation for flaring up of the lichen planus
– Biopsy: It’s completed to know the extent of the pores and skin lesion
– Hepatitis C check: As typically lichen planus is related to hepatitis C virus
Can lichen planus be prevented?
No, because the causation shouldn’t be clearly understood, there isn’t any approach to stop lichen planus.
Is lichen planus contagious?
Lichen planus shouldn’t be contagious. Lichen planus can not unfold to a different individual by unprotected intercourse or pores and skin to pores and skin contact.
Remedy and Administration
Antihistamines: These are given to alleviate itching of various levels
Topical corticosteroid cream: Cream or ointment to scale back swelling and redness
Oral corticosteroids: Capsules or injections of corticosteroids assist when lichen planus lasts for very long time or when affected person has many bumps or painful sores
PUVA remedy: A sort of sunshine therapy which makes use of ultraviolet gentle, often ultraviolet B from particular lamps, might assist to clear the pores and skin lesions
Retinoic acid: That is utilized to the pores and skin or given as a capsule to assist the pores and skin lesions
Immunosuppressants: Medicines that decrease the immune system corresponding to oral corticosteroids, mycophenolate mofetil, azathioprine or cyclosporine may be useful
The best way to dwell with the situation
Apply of fine oral hygiene: Common brushing and flossing the enamel, and getting checked and cleaned by skilled dentist not less than twice a yr
Exchange dental fillings: Some individuals may need allergy symptoms to the mixtures of various mixtures of metals utilized in tooth fillings. These allergic reactions may appear like lichen planus. Changing the dental fillings with hypo allergic mixture may enhance the redness and soreness in oral mucosa
Keep away from pores and skin accidents
Use cool compress throughout excessive itching and painful phases as a substitute of scratching, as scratching additional exacerbates the situation
Stress within the life needs to be managed as stress acts as triggering issue
To take management of signs of oral lichen planus, stopping smoking, avoiding alcohol, sustaining good oral hygiene and avoiding all meals which may irritate the oral mucosa are obligatory.
Emotional or psychological stress that worsens lichen planus signs
– Nervousness
– Despair
– Issue enjoyable
– Use of alcohol, tobacco or medicine to alleviate stress
– Low self worth
– Feeling overwhelmed
– Issue in concentrating
– Temper swings, irritability or a brief mood
Prognosis of Lichen Planus
The prognosis for lichen planus is usually favorable, regardless of the average to extreme itching that usually accompanies the situation. Most circumstances resolve inside 18 months. Nonetheless, it is very important be aware that some lesions might recur over time.
Pores and skin lichen planus doesn’t improve the danger of pores and skin most cancers. Nonetheless, ulcerative lesions within the mouth, notably in males, carry a low however notable danger of transformation into most cancers. Moreover, vulvar lichen planus has been related to an elevated danger of creating squamous cell carcinoma. General, whereas lichen planus could cause vital discomfort and potential issues, the long-term outlook is constructive for many sufferers with correct administration and monitoring.
Examine – Lichen planus is a illness of adults (20-40 years) in keeping with western knowledge, however within the Indian inhabitants it is not uncommon within the pediatric age group (lower than 18 years age group). The illness is comparatively extra frequent in females than in males. Classically it has a powerful affiliation of involvement of the decrease limbs within the youthful age group. Involvement of the higher limb is extra frequent in feminine sufferers.
Examine – ‘A research of despair and high quality of life in sufferers of lichen planus’ – confirmed a powerful affiliation between despair and impairment in high quality of life in each genders affected by lichen planus. This research helps in early identification of psychological issues in lichen planus sufferers and in planning their future course of administration, therefore lowering the dearth of productiveness and enhancing the prognosis and high quality of life.
Epidemiological research – Compared to the traditional inhabitants, there’s a greater prevalence of hepatitis C virus an infection in sufferers struggling with lichen inhabitants.
Lichen Planus: Ayurveda Understanding
From dosha perspective, being an inflammatory situation, Lichen Planus is unquestionably attributable to pitta aggravation. It’s also triggered by pitta aggravating etiological elements. Itching in Lichen planus is attributable to aggravated kapha, vata or each kapha and vata.
Lichen planus is manifested on the pores and skin and is primarily a pores and skin situation / illness. Due to this fact, it may be included beneath ‘Kushta’. The signs of Alasaka, Udumbara / Audumbara, Mandala, Pundarika and Pama Kushtas resemble the medical image of Lichen Planus.
The reason of Lichen Planus additionally consists of it beneath the class of raktagata or pittaja kushta.
The etiological elements talked about within the context of Kushta, vitiation of rasavaha and mamsavaha srotas and tridosha imbalance may be thought-about within the causation of lichen planus.
Nidana Parivarjana i.e. maintaining away the causative elements of kushta and people which contaminate channels of transportation of rasa, rakta and mamsa are the primary rules for stopping the development of the illness, stopping it within the prone individuals and to stop the recurrence of the illness and its signs.
When manifested, lichen planus shall be handled on the traces of treating kushta and contamination of the talked about channels. Virechana and Vamana are an important Panchakarma therapies that are extremely efficient within the therapy and administration of lichen planus.
As and when required, exterior therapies like lepa and parisheka as defined within the context of kushta and vatarakta – for aid of signs like itching and irritation, Rasayana – for stopping the recurrence and full restoration, Sattvavajaya Chikitsa – psychotherapy to handle stress, which is a crucial set off, Daiva Vyapashraya Chikitsa – divine and perception therapies contemplating lichen planus as idiopathic situation, therapy rules of krimi – microorganisms, and visha chikitsa needs to be thought-about.
Shodhana and Rasayana therapies needs to be deliberate and administered for ‘dad and mom to be’ in order that they get wholesome infants into the world, particularly in presence of household historical past of lichen planus on one or either side of the households.
Associated Studying – ‘Lichen Planus – Ayurveda Understanding’
