About Your Diagnosis

Lichen planus is a skin condition that has no known cause. It usually occurs in the middle decades of life (30–60 years of age). Lichen planus has no known racial or sexual preference. It consists of small, raised, many-sided lesions that are red or purple and have white lines on the top of them. The lesions are typically itchy and occur most frequently on the wrists, arms, ankles, male genitals, the back of the hands, and the front of the lower legs. They may also occur in the mouth and the female genital area, but they have a different appearance in these areas. New lesions may occur in areas in which the skin has been scratched or traumatized. This is not caused by spreading any germ or toxic substance but by the way the skin reacts in this disorder. Nails may also be involved in some cases; they are frequently thin and have ridges.

Living With Your Diagnosis
The disorder is not very common but is seen in about 1% of all the patients seen by skin specialists. There is no known cure, although some treatments may bring about a remission. The disease tends to resolve after 6–18 months, but in some patients it will recur. You cannot give this disease to others by contact or by the spread of germs. It is also not known to be inherited or to run in families. There are some drugs that tend to cause lichen planus– like reactions, including gold, antimalarials, penicillamine, tetracycline, diuretics, quinidine, quinine, propranolol, captopril, and methyldopa. Photographic developers can also cause this type of rash. You should review all your medications and chemical exposures with your physician. The diagnosis of lichen planus can be made by its appearance and by a biopsy (taking a small piece of skin to look at under the microscope). No other laboratory tests are useful. However, your doctor may ask you to discontinue a medication that is known to be related to the disorder. Check with the physician that prescribed the medication if the medication is for a chronic condition, such as high blood pressure. You may need a substitute medication.

Treatment
There are multiple treatments of this disorder. Because the cause of the disorder is not known, there is no single treatment that controls the problem in all patients. Some of these treatments are to control the symptoms, and some may decrease the number of lesions. Antihistamines are given for the itching. Cortisone- like medications are the most frequent drugs used. They are applied as creams, injected into the lesions, or taken by mouth. Griseofulvin, dapsone, phototherapy, and systemic retinoids are other types of therapy that may be used. Because of the various treatments for the disorder, the problems and side effects of each treatment are also diverse. Cortisone-like (steroids) creams can cause thining and pigment changes of the skin when used for a long period. These same effects can be seen when the drugs are injected into the lesions. When steroids are taken by mouth and in fairly large doses for a long period, multiple side effects can occur including weight gain, elevated blood sugar, high blood pressure, susceptibility to infections, and cataract formation. The side effects of all the various treatments are beyond the scope of this chapter. Be sure and discuss these with your doctor if other treatments are used.

The DOs
There is no specific diet, exercise, or other medications that will improve this condition. Because it is a condition caused by inflammation, and trauma can cause further lesions, gentle treatment of the skin is indicated.

The DONT’S
• Avoid over-the-counter medications, perfumes in creams or lotions, or anything that can irritate the skin.
• Avoid excessive sun exposure because sunburn is traumatic to the skin. (Sun exposure itself is not known to make this condition worse.)

When to Call Your Doctor
•If the lesions in the mouth become so painful that you cannot eat.
• If the lesions on the other parts of the skin are scratched and become infected and drain pus.
• If irritation of the eye develops when you have this condition, you should see an eye doctor (ophthalmologist).

Websites:
The Internet Dermatology Society
http://netaxis.com/rdrugge/work/html