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  Lichen planus

Lichen planus is a recurrent inflammatory skin condition characterized as small, flat-topped, polygonal or many-sided bumps that can erupt together into rough, scaly patches on the skin. The disease got its name from the Latin word “planus” which means flat and “Lichen” which refers to a tree moss. The rashes may also be present in the inner lining or mucous membranes of the mouth or vagina. The effects of Lichen planus are typically localized to the areas of involvement.

Lichen planus Skin diseases
Lichen planus

Most typical lichen planus cases are relatively easy to diagnose because physicians can make the diagnosis by simply looking at the characteristic rash. A skin biopsy (e.g. punch biopsy, a cylindrical 2 to 5 millimeter diameter plug of tissue) may be necessary to help confirm the diagnosis especially in cases of persistent oral or vaginal lichen planus. This is due to the fact that the lesions of the aforementioned condition appear as spots that thicken and tend to grow together making them difficult to differentiate from the whitish pre-malignant plaques called leukoplakia. Examination under the microscope is valuable to the examiner, specifically showing the distinct appearance of Lichen planus.

Some widespread lichen planus especially if accompanied with erosions in the mouth can also be confusing to other conditions like oral candidiasis or oral thrush (a yeast infection caused by Candida albicans); mouth ulcers (aphthous ulcers) and other oral or mouth carcinoma or cancers. A biopsy may be necessary to arrive at a more accurate diagnosis and can confirm if the lesions are indeed benign or malignant so that appropriate treatment approach may be employed.

Majority of lichen planus cases are relatively mild. Those individuals affected with this disease who are asymptomatic do not need treatment at all. However, if the itchiness is very distressing causing extreme discomfort to the patient or if the appearance of the rashes is unsightly, then topical corticosteroid creams may be useful. Sometimes, injectable corticosteroids may be given. Antihistamines may resolve the itchiness, particularly if it is only mild to moderate. This is due to the fact that older antihistamine such as diphenhydramine (benadryl) also has a sedative effect as part of its therapeutic action in contrast to the newer antihistamines like loratadine (Claritin) and cetirizine (Zyrtec) which does not have a sedating action. In more severe cases of Lichen planus, physicians may recommend oral medications or therapy with the use of ultraviolet light (UVA). Oral medications may include a short course of oral corticosteroids such as prednisone. However, the itching may recur after the drug has been discontinued hence; a low-dose oral corticosteroid taken every other morning may be also prescribed instead of discontinuing the drug completely. With persistent symptoms of itchiness, ultraviolet light (PUVA) treatment otherwise known as phototherapy may help. For those with painful lesions within the mucous membranes of the mouth such as mouth sores or ulcers, the use of topical mouthwashes containing an anaesthetic (e.g. lidocaine, xylocaine) before meals may provide symptomatic relief. In cases where a drug or a chemical substance is suspected to be the causative agent of the lichen planus then this should be discontinued immediately.

In summary, Lichen planus is considered to be generally mild but a recurrent skin disease. Although relatively mild, this may cause distressing symptoms that must be managed seriously in some cases. Another important aspect is to be careful in confirming the diagnosis that skin condition that the patient is having is really Lichen planus and not due to other more serious conditions like cancer. Sometimes, it is difficult to distinguish it by just basing on the clinical appearance hence; if biopsy is needed then pursue the test to confirm the diagnosis.

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