Lichen planus

What is Lichen Planus?

Lichen planus is a common non contagious inflammatory disease of the skin and mucous membranes.  Since it has lichen-like appearance it is called as Lichen planus.

Variants of Lichen Planus

1. Annular Lichen Planus- It appears ring-shaped lesion which develops slowly from single small spot into the circular group of eruptions with a clear skin in the centre.
2. Linear Lichen Planus – Lesions are arranged in a linear pattern.
3. Hypertrophic Lichen Planus – It appears like reddish brown, thick skin rash looks like hypertrophied scar. This type has more itching than the other types.  It usually affects the hands, legs, and certain joints.
4. Atrophic Lichen Planus – It appears bluish-white eruption with central atrophy.
5. Bullous Lichen Planus – It appears like bullae/blister.
6. Pigmented Lichen Planus (LPP) – It appears dark, hyperpigmented lesion over the sun-exposure areas. It mainly affects the face, neck, limbs.
7. Ulcerative Lichen Planus – It appears ulcer-like, painful bullae/blister.
8. Oral mucosal lichen planus is a form of mucosal lichen planus, where lichen planus involves the oral mucosa ( the lining of the mouth)

There are 6 clinical forms of Oral Lichen Planus recognized:

1. Reticular form: The most common form of oral lichen planus, is characterised by spider web-like appearance of lacy white lines, oral variants of Wickham’s straiae. It is usually asymptomatic.
2. Ulcerative or erosive:  The second most common form of oral lichen planus, is characterised by oral ulcers presenting with persistent, irregular areas of redness, ulcerations and erosions covered with a yellow slough. This can occur in one or more areas of the mouth. In some people with erosive oral lichen planus, the gums are involved known as desqamative gingivitis.
3. Plaque form- This appears as a white patch which may resemble leukoplakia
4. Papular form- It has white papules.
5. Bullous form– This appears as fluid-filled vesicle.
6. Atrophic form- This appears as an atrophied area.

Causes of Lichen planus

The cause is unknown, but it is thought to be the result of an Auto-immune process with an obscure trigger. 

1. Genetic causes
2. Emotional stress and anxiety can trigger Lichen planus.

1. Mercury exposure
2. Drug exposure such as  beta blockers, anti malarial medicines, NSAIDs (nonsteroidal anti inflammatory drugs)
3. Chemical exposure such as gold compound, bismuth, development of color photography etc
4. Diseases such as hepatitis B and hepatitis C
5. Reactions to amalgam- Amalgam dental fillings may trigger allergic reactions and thus formation of oral lesions of lichen planus.

Symptoms of Lichen Planus:

Skin Lichen planus

1. Purplish colour eruptions with flat top.  Mostly found on the inner aspect of forearm, wrist, nails, palms and soles, scalp, hair, ankles, and knees but can be found anywhere. 

2. Nails- Thining of the nails.  Irregular longitudinal grooving and ridging of the nail plate.  Atrophy of the nail bed, longitudinal red streaks and sand papered-appearance.

3. Hair and scalp- Inflammation of hair follicles and scaly, itchy papules over the scalp. If untreated may lead to scarring alopecia.

Mucosal Lichen Planus:

Mucosal lichen planus mostly affects eyes, ears, nose, oesophagus, and bladder etc.

1. Conjunctivae- It is a rare condition but when affects it is very painful.
2. Oesophageal- This leads to narrowing of the oesophagus with pain or difficulty in swallowing.  Swelling/inflammation of the tube.  If untreated may end up in carcinoma of oesophagus.
3. Bladder- Inflammation of the bladder with lower urinary tract infection which includes itching, narrowing of the urethra and thus painful urination.
4. Genital- Lesions on the vagina and vulva in females and it affects glans penis or skin of the scrotom in males.

Oral Lichen Planus

In oral lichen planus, there are small, raised, pale areas that form spider web-like lacy white lines on the inside of the cheeks.  Generally there is no discomfort or pain, though some people may experience pain, burning/soreness while eating hot, spicy acidic foods or drinking harsh, pungent beverages.  There is dry mouth with metallic taste or blunted taste sensation.

Prevention of Lichen Planus:

Cutaneuous Lichen planus:

1.  Avoid scratching the lesions- scratching may worsen the case.

2.  Avoid stress- stress can worsen the case either.

Mucosal and Oral Lichen planus:

1.  Keep oral cavity clean.

2.  Brush and floss immediately after food.

3.  Avoid alcohol consumption and cigarette smoking.

4.  Avoid spicy foods and irritating fruits (citrus fruits-like orange, mosambi, amla; pineapple).

Conventional treatment for Lichen Planus:

Corticosteroids cream and tablets, analgesics, antihistamines, phototherapy and retinoid.

Corticosteroids suppresses the immune system which leads to suppression of disease and hence it causes frequent flare up of lesions on any other part of the body.

Homeopathic treatment for Lichen Planus:

Being an auto immune disease the root cause of Lichen Planus lies in altered immunity. Homeopathy targets and modulates this altered immunity to give deep level healing. It helps in arresting the progression of disease initially thereafter helps in giving symptomatic relief such as reduces itching, reduces size and spots of Lichen Planus. Further it helps in minimizing the chances of relapse by further improving the immunity.

It also helps in reducing the side effects of conventional medicines which may includes steroids and other immunosuppressant medicines. Homeopathic medicines treats the lesions of Lichen Planus naturally without causing any side effects on any part of the body.

Homeopathic medicines are herbal in nature and can be consumed for longer period of time depending on the chronicity of the disease.