Lichen Planus Treatment

About

Lichen Planus Treatment

What is lichen planus?

Lichen planus is a chronic (long term) inflammatory condition that causes swelling and irritation, and an itchy rash on the skin or inside the mouth. It may be caused by the immune system mistakenly attacking the skin and mucous membranes. In the mouth, lichen planus can cause burning or sore mucus membranes. It can also develop on the scalp, nails, and genital area. 

There is no cure and it is not contagious. Self-care treatment is usually all that is needed to control pain and itching. If it causes significant pain or itching, oral antihistamines and topical creams can be helpful. Severe cases can cause serious health problems. 

What is oral lichen planus?

Oral lichen planus means the condition affects mucous membranes inside the mouth, or on the lips or tongue. White, lacy patches may form, or tissue can become red and swollen. Some people develop open, painful sores. It’s possible to have outbreaks on both the skin and inside the mouth. Also not contagious, oral lichen planus can be managed with self-care. Regular checkups, at least annually, are important because it increases the risk of mouth cancer. 

Do I need to worry about lichen planus?

It depends on how severe it is. Severe cases can cause significant pain, stress and anxiety, even depression. Lichen planus in the ear canal can cause hearing loss if not treated. Severe cases of oral lichen planus can increase your risk of:

  • Weight loss due to inability to eat, leading to nutritional deficiency
  • Infections caused by oral yeast or fungus
  • Scarring from sores or lesions
  • Oral cancer
  • Sexual dysfunction because of painful genital sores and scars

Causes

What causes lichen planus?

The cause is not known, but it may be an autoimmune disease, which causes the immune system to mistakenly attack the body. A rare type of lichen planus (familial bullous) runs in families.  

It’s important to get an accurate diagnosis because other conditions can look like lichen planus. Diuretics, used to treat heart disease, and medicines that prevent malaria can cause a similar rash. Many people with a hepatitis C virus infection also have lichen planus. Although it’s very rare, a metal filling may be the cause or oral lichen planus. Replacing it with a non-metal filling usually stops the lichen planus.

Although anyone can develop lichen planus, it’s most common in middle-aged people. Women develop oral lichen planus more frequently than men. Certain conditions can trigger a lichen planus outbreak, including:

  • Medications for arthritis, heart disease, high blood pressure, and over-the-counter pain relievers such as Advil or Aleve
  • Flu vaccine
  • Hepatitis C infection
  • Certain chemicals and metals
  • Any condition that lowers your immunity

Oral lichen planus can be triggered by mouth injury, infections or something the person is allergic to such as dental materials. Stress can cause it to get worse or recur.

With Insurance

Dermatology

Your copay
Depending on insurance

Without Insurance

Dermatology

$89

Initial Visit

$75

Follow Up

Symptoms

What are the symptoms of lichen planus?

Symptoms of lichen planus depend on where it develops. 

In the mouth, lips or tongue it may cause:

  • White, lacy patches
  • Painful sores on the insides of the cheeks, gums, tongue, inside of the lips and on the palate (roof of the mouth)
  • Bright red, swollen gums that can peel
  • Burning sensations inside the mouth
  • Sensitivity to spicy foods, hot or acidic foods
  • Bleeding and irritation when brushing your teeth
  • Thick painful patches on the tongue
  • Discomfort when chewing, swallowing or even speaking

On the skin, it forms reddish-purple, itchy, shiny, firm bumps or rash. Sometimes the flat-topped bumps have tiny white lines through them. Most people have a few bumps, but others have many, appearing on different parts of the body, over a period of a few weeks. Bumps are most likely to develop on wrists, forearms, lower back, legs, ankles, and sometimes in the genital area. As the bumps appear to heal, more bumps develop. After lichen planus heals, it can leave dark spots on the skin in the affected area.

Other symptoms may include:

  • Patches of thick, rough and scaly skin, especially in areas where bumps keep returning; are more common on legs and ankles.
  • Itching that’s worse on the thick patches of skin
  • Blisters are not common but do occur, forming scabs or crusts
  • Nail damage or loss of nails

In the genital area, and other areas with mucus membranes, red, eroded, burning, painful lesions can develop. Occasionally there may be white areas as well. 

In the ears, lichen planus can lead to hearing loss if it is not treated. 

On the scalp, it can cause patches of temporary or permanent hair loss, redness and irritation, bumps and scars after the area heals. However, it rarely occurs on the scalp. 

Finger and toenails can be affected, although it’s rare. The result can be thin, split nails, ridges/grooves on the nails, and temporary or permanent loss of nails.

Eyes are rarely involved, but lichen planus on the mucous membranes of the eyes can cause scarring and blindness.
Esophagus is rarely affected, but it can become narrowed, or form tight, ringlike bands that make swallowing difficult.

Diagnosis

How is lichen planus diagnosed?

Your dermatologist can diagnose lichen planus by examining the bumps, listening to your symptoms, and taking your health history. Laboratory tests may be needed to confirm the diagnosis. Lab tests may include a biopsy of the affected tissue, a Hepatitis C test, or allergy tests.

Treatment

How is lichen planus treated?

Treatment for lichen planus focuses on healing the most severe sores and reducing pain and itching. Some cases clear up on their own, but it may take several months to two years. About 20% of people will have second or more outbreaks. The condition can come and go for years. 

When it affects mucous membranes, it’s harder to treat successfully, and often recurs. Patients who require treatment may receive medications to help relieve pain, itching and help the skin heal. Some medications can cause side effects. It’s important that patients have the information needed to weigh the benefits against the negative side effects of treatment. 

  • Antihistamines can help relieve itching.
  • Prescription corticosteroid cream or ointment can help with small outbreaks. A corticosteroid pill or injection may be prescribed if the bumps or sores are widespread. 
  • Anti-infection drugs or antibiotics can help with secondary infections.
  • Immune response medications may be needed in severe cases to suppress or tamp down the immune response. They may be prescribed as topical ointments/gels, or as pills or injections when lichen planus affects the scalp, esophagus or genital area. 
  • Phototherapy uses light to stop lichen planus bumps and rash on the skin. It usually requires two to three treatments a week for several weeks.
  • Retinoids may be prescribed if steroids or phototherapy don’t work.

Oral lichen planus may be treated with numbing drops to provide temporary relief for painful areas. Corticosteroid, to reduce inflammation, may be prescribed as a mouthwash, ointment or gel that’s applied directly to mucus membranes; or as a pill or injection directly into the sore.  

Self-care measures include:

  • Practice good oral care, (brush twice and floss every day), including regular dentist visits. Keeping the mouth clean helps reduce symptoms, and lowers your infection risk.
  • Reduce or eliminate spicy, salty or acidic foods (citrus fruits and tomatoes), and caffeine.
  • Avoid tobacco in any form, and alcohol.
  • Manage stress, it can worsen symptoms and cause flare-ups.
  • Use cool compresses and oatmeal baths to reduce itching. 
  • Protect skin from injuries. Even a small injury can cause an outbreak.
  • Get an oral cancer screening at least every year.

References

Mayo Clinic. (March 2021). Lichen Planus. Retrieved 9-22-21, {https://www.mayoclinic.org/diseases-conditions/lichen-planus/symptoms-causes/syc-20351378}
Mayo Clinic. (Dec. 2019). Oral Lichen Planus. Retrieved 9-22-21, {https://www.mayoclinic.org/diseases-conditions/oral-lichen-planus/symptoms-causes/syc-20350869}
American Academy of Dermatology Association. (N.d.). Lichen Planus: Signs and Symptoms. Retrieved 9-22-21, {https://www.aad.org/public/diseases/a-z/lichen-planus-symptoms}
American Academy of Dermatology Association. (N.d.). Lichen Planus: Diagnosis and Treatment.  Retrieved 9-22-21, {https://www.aad.org/public/diseases/a-z/lichen-planus-treatment}

Information

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

Meet our doctors

TM2U Curve inverted

Affordable –
with or without insurance

With Insurance

Dermatology

Your copay
Depending on insurance

Without Insurance

Dermatology

$89

Initial Visit

$75

Follow Up