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. Referred to as lichenoid dermatitis amongst healthcare professionals, this situation manifests as purple, itchy, flat elevated lesions on the pores and skin, typically growing over a number of weeks. These lesions will be significantly bothersome as a consequence of their look and the extraordinary itching they trigger.
Within the mouth and genital areas, lichen planus typically presents as lacy white patches, which might typically be accompanied by painful sores. Though it will possibly have an effect on anybody, the situation is mostly seen in middle-aged adults and is understood for its unpredictable course, the place signs could resolve inside months however have the potential to recur.
Early recognition and acceptable administration might help alleviate signs and stop issues, making a complete data 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 will not 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 will not be an autoimmune situation, however the responses resemble immunity issues. 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 operate of defending the physique from infections. Nonetheless, in folks 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 primary causes will be outlined as underneath:
– Allergens
– Viral infections
– Stress
– Genetics
– In few circumstances, lichen planus happens together with the autoimmune issues
Indicators and Signs of lichen planus
The final 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 inside forearms, wrists or ankles
– Lacy white patches on the tongue or within cheeks
– Reasonable 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 line with physique elements it impacts
Pores and skin: The commonest signs are purple or purple raised pores and skin lesions sometimes called bumps. These bumps are agency and should itch so much or little. They could be few in quantity to quite a lot of them and could also be related to white traces or scales. They’ll happen anyplace, 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 gentle instances, they might not trigger any signs in any respect or few signs, however in extreme situations, they trigger redness and soreness.
Nails: Lichen planus could seem on a couple of, or all the fingernails and toenails. Thinning, ridge forming, splitting and nail loss are the indicators of this situation.
Scalp: Tiny bumps, redness, and irritation will be seen on the scalp. In sure instances, hair thinning and hair loss can be noticed.
Genitals: Redness and soreness are the principle 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 growing after per week or extra and intensive 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 instances.
Persistent lesions are extra seemingly oral lichen planus or with giant 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 metallic 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
– Specific chemical substances, 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 recommend that girls may get lichen planus twice as typically as males, and they’re extra prone to develop it of their 60s. Males usually tend to develop of their 40s.
Issues
Lichen planus will 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 could improve the chance of oral most cancers.
Lichen planus if impacts the ear, it could 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 harm, hyperlipidemia, and progress restriction in youngsters could happen as a consequence of hostile results of remedy.
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 any 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 elements of the USA reported to have noticed increased 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 undergo from lichen planus.
Age: Greater than two third of lichen planus sufferers are aged between 30-60 years; nonetheless, it will possibly 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 %.
Frequent diagnostic standards of lichen planus
It’s sometimes recognized after the evaluation of signs and bodily examination. Lichen planus has some particular characters that are recognized 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 take a look at: An allergy take a look at completed can decide if allergy is the rationale for flaring up of the lichen planus
– Biopsy: It’s completed to know the extent of the pores and skin lesion
– Hepatitis C take a look at: As typically lichen planus is related to hepatitis C virus
Can lichen planus be prevented?
No, because the causation will not be clearly understood, there isn’t any option to forestall lichen planus.
Is lichen planus contagious?
Lichen planus will not be contagious. Lichen planus can’t unfold to a different individual via unprotected intercourse or pores and skin to pores and skin contact.
Therapy 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: Drugs 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 kind of sunshine therapy which makes use of ultraviolet mild, often ultraviolet B from particular lamps, could assist to clear the pores and skin lesions
Retinoic acid: That is utilized to the pores and skin or given as a tablet to assist the pores and skin lesions
Immunosuppressants: Drugs that decrease the immune system similar to oral corticosteroids, mycophenolate mofetil, azathioprine or cyclosporine will be useful
The way to stay with the situation
Observe of excellent oral hygiene: Common brushing and flossing the tooth, and getting checked and cleaned by skilled dentist no less than twice a yr
Substitute dental fillings: Some folks might need allergy symptoms to the mixtures of various mixtures of metals utilized in tooth fillings. These allergic reactions may appear to be 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 that may irritate the oral mucosa are obligatory.
Emotional or psychological stress that worsens lichen planus signs
– Anxiousness
– Melancholy
– Issue enjoyable
– Use of alcohol, tobacco or medication 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 mostly favorable, regardless of the reasonable to extreme itching that always accompanies the situation. Most instances resolve inside 18 months. Nonetheless, it is very important word that some lesions could recur over time.
Pores and skin lichen planus doesn’t improve the chance of pores and skin most cancers. Nonetheless, ulcerative lesions within the mouth, significantly 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 growing squamous cell carcinoma. Total, whereas lichen planus could cause vital discomfort and potential issues, the long-term outlook is optimistic for many sufferers with correct administration and monitoring.
Examine – Lichen planus is a illness of adults (20-40 years) in line with western information, however within the Indian inhabitants it’s common 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 robust 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 examine of melancholy and high quality of life in sufferers of lichen planus’ – confirmed a robust affiliation between melancholy and impairment in high quality of life in each genders affected by lichen planus. This examine 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 increased 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 is usually 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 underneath ‘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 underneath 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 will be thought of within the causation of lichen planus.
Nidana Parivarjana i.e. holding away the causative elements of kushta and people which contaminate channels of transportation of rasa, rakta and mamsa are the principle rules for stopping the development of the illness, stopping it within the prone folks 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 crucial 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 reduction of signs like itching and irritation, Rasayana – for stopping the recurrence and full restoration, Sattvavajaya Chikitsa – psychotherapy to handle stress, which is a vital 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 of.
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’
