Lichen planus (pronounced LY-kin-PLAN-us) is a common inflammatory disease of the skin and mouth. It affects about one to two percent of the general population. The name "lichen" refers to the lichen plant which grows on rocks or trees, and "planus" means flat. What is lichen planus (LP)? To understand what LP is, it is important to note what the disease is not. LP is not an infectious disease. It is impossible to catch LP from someone or to give it to someone else. The disease is not a form of cancer, it does not appear to be inherited, and it is not related to nutrition.
LP is an inflammatory disease that affects the skin, the mouth (oral), or both. It may also affect the genital skin. Skin LP affects men and women equally, but oral LP affects women twice as often as men. LP occurs most frequently in middle-aged adults. The cause of LP is not known. While there are many theories to explain LP, most dermatologists believe it can be classified as an autoimmune disease. This means that white blood cells which usually fight germs begin to attack the normal parts of the skin, mucous membranes, hair, and nails. There are cases of lichen planus-type rashes which occur as allergic reactions to medications for high blood pressure, heart disease, and arthritis. Identifying and stopping the drug helps clear up the condition within a few weeks. LP of the mouth most commonly occurs inside of the cheeks, but can affect the tongue, lips, and gums. Oral LP is more difficult to treat and typically lasts longer than LP on the skin. Fortunately, many cases of LP of the mouth cause minimal problems. About one in five people who have oral LP also have skin LP. This may be the problem which not many dentists would recognize. This is usually treated by a dermatologist. But, I would see the oral surgeon for a firm diagnosis. If they don't know, than see a board certified dermatologist. I can certainly understand your anxiety over this situation. I hope that everything will be OK. Take care.
The smooth white patches
on the tongue are lichen planus
Oral LP typically appears as patches of fine white lines and dots which usually do not cause problems. Dentists often find them during routine check-ups. More severe forms of oral LP can cause painful sores and ulcers in the mouth. Your dermatologist may have to make sure that the sores are not caused by a yeast or an infection and are not canker sores. A biopsy of affected tissue may be needed to confirm a diagnosis. Sometimes, the biopsy tissue must be studied by a special technique and blood tests may be needed to rule out other oral diseases.
Lichen planus of the gums
produces redness and yellowish ulcerations.
There have been cases of lichen planus-like allergic reactions to dental materials but they are very rare. Patch testing may be used to pinpoint the allergy; removing dental material is recommended.
Treatment for LP of the Mouth
There is no known cure for oral LP although there are many treatments that eliminate the pain of sores. When the disease causes no pain or burning, treatment may not be needed. More severe forms of LP - those with pain, burning, redness, blisters, sores, and ulcers - can be treated with a variety of medications, both applied to the sores (topical) and taken by mouth (oral). As with any disease of the lining of the mouth, LP can lead to poor dental hygiene and gum disease. Careful daily oral hygiene is very important. Schedule regular visits to the dentist for examinations and cleanings at least twice a year.
Are you at risk?
Patients with oral LP may be at a slightly increased risk of developing oral cancer. Because of this increased risk, it is wise to discontinue the use of alcohol and tobacco products which also increase the risk. Regular visits to the dermatologist - every six to twelve months - for an oral cancer screening is recommended.
Food for Thought
Spicy foods, citrus juices, tomato products, caffienated drinks like coffee and cola, and crispy foods like toast and corn chips can aggravate LP especially if there are open sores in the mouth.
Lichen Planus of the Genitals
LP of the genitals is less common in men than women. About one in five women have vulvar or vaginal LP. There may be no problems if it is mild, but red areas or open sores may cause pain, especially with sexual intercourse and needs treatment.
Nail changes have been observed in LP. The majority of nail changes result from damage to the nail matrix, or nail root. Only a few fingernails or toenails are usually involved, but occasionally all are affected. Nail changes can occur with or without skin involvement.
Lichen planus affecting the fingernails shows thinning and
surface roughnesss of the nail plate with longitudinal ridges
Nail changes associated with LP include longitudinal ridging and grooving, splitting, nail thinning, and nail loss. In severe cases, the nail may be temporarily or permanently destroyed.
LP can affect hairy areas such as the scalp in rare cases. This is called lichen planopilaris, and can lead to redness, irritation, and in some cases, permanent hair loss.
Lichen planus of the scalp causes
inflammation, hair loss and scarring.
More on Lichen Planus
LP may be unpleasant and difficult to treat, but it is a stable condition. The severity and distribution of the disease rarely changes after the first few months. Although there is no cure for LP, your dermatologist will be able to develop a treatment plan to control your symptoms.
To learn more about lichen planus, call toll free (888) 462-DERM (3376) to find a dermatologist in your area.
AAD Web site: www.aad.org
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National Library of Dermatologic Teaching Slides
©2006 American Academy of Dermatology
Revised 1995, 200, 2004
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