The cause of lichen planus is not known, however there are cases of lichen planus-type rashes (known as lichenoid reactions) occurring as allergic reactions to medications for high blood pressure, heart disease and arthritis. These lichenoid reactions are referred to as lichenoid mucositis (of the mucosa) or dermatitis (of the skin). Lichen planus has been reported as a complication of chronic hepatitis C virus infection. It has been suggested that true lichen planus may respond to stress, where lesions may present on the mucosa or skin during times of stress in those with the disease. Lichen planus affects women more than men 3:2, and occurs most often in middle-aged adults. Lichen planus in children is rare.

Clinical features

The typical rash of lichen planus takes the form of well-defined, purplish, polygonal, extremely itchy bumps on the skin. The commonly affected sites are near the wrist and the ankle. The rash tends to heal with prominent blue-black or brownish discoloration that persists for a long time. Besides the typical lesions, many morphological varieties of the rash may occur.

The presence of lesions is not constant and may wax and wane over time.

Inside the mouth, the disease may present in the (1) reticular form or in the (2) erosive form. (1) The reticular form is the more common presentation and manifests as white lacy streaks on the mucosa (known as Wickham's striae) or as smaller papules (small raised area). The lesions tend to be bilateral and are asymptomatic. The lacy streaks may also be seen on other parts of the mouth, including the gingiva (gums), the tongue, palate and lips. (2) The erosive form presents with erythematous (red) areas that are ulcerated and uncomfortable. The erosion of the thin covering of cells (the epithelium) may occur in multiple areas of the mouth, or in one area, such as the gums. Wickham's striae may also be seen near these ulcerated areas.

Lichen planus may also affect the genital mucosa. It can resemble other skin conditions such as atopic dermatitis and psoriasis.

Differential Diagnosis

The clinical presentation of lichen planus may also resemble other conditions, including:

Lichenoid drug reaction
Lupus Erythematosus
Chronic Ulcerative Stomatitis
Pemphigus Vulgaris
Benign Mucous Membrane Pemphigoid

A biopsy is useful in identifying histological features that help differentiate lichen planus from these conditions.

Cure

Currently there is no cure for lichen planus but there are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports that lichen planus can flare up years after it is considered cured.

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Lichen Planus
From American Family Physician, 10/1/99 by Anne D. Walling

(Australia--Australian Family Physician, April 1999, p. 369.) Lichen planus is an uncommon skin condition that can occur in the genital area, on the arms, legs, trunk and in the mouth. The cause is unknown, but it is believed to be autoimmune, possibly triggered by viral infection. The condition is more common in women and usually affects persons 30 to 60 years of age. The onset is slow, with pruritic plaques developing over several months and resolving within 18 months. The "four P's" describe the lesions--purple, polygonal and pruritic papules. White surface lines known as Wickham's striae are characteristic of lichen planus. Treatment may not be necessary unless erosion or secondary infection occurs. Topical corticosteroids are frequently used to reduce itching and induce regression of the lesions. Hyperpigmented areas may persist after the lesion has resolved.

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