Lichen Planus – Diagnosis and Treatment
Diagnosis
Doctors usually begin diagnosing lichen planus by reviewing the person’s medical background, symptoms, and conducting a detailed physical exam.
They can often spot typical signs like Wickham striae, purple skin lesions, or inflammation on the skin, nails, or oral mucosa.
When the diagnosis is unclear or in cases with unusual features such as scalp or genital involvement, doctors may perform a biopsy to confirm lichen planus by identifying classic patterns under a microscope.
Tests doctors may use:
| Test Type | Purpose |
|---|---|
| Biopsy | Examines tissue for cell changes of lichen planus |
| Blood tests | Screens for related issues like hepatitis C |
Doctors may order further tests like direct immunofluorescence for oral lichen planus or vulvar lichen planus to rule out other inflammatory problems or risk of malignant transformation.
Recognizing clinical features early allows for better management and monitoring for complications such as ulcers, hyperpigmentation, and chronic inflammation.
Treatment
Using Steroid-Based Creams and Pills
Doctors often use topical corticosteroids as the first step in treating lichen planus that affects the skin. These medications, including creams and ointments, help lessen swelling, redness, and itching.
If topical treatments do not work well, doctors may prescribe stronger forms like corticosteroid tablets or injections, especially for larger areas or more severe symptoms.
Side effects depend on how the medicine is used, so following instructions from a healthcare provider is important.
Medicines Against Infections Taken by Mouth
Doctors sometimes prescribe oral anti-infective or anti-inflammatory medications for certain cases of lichen planus.
These may include antimalarials (commonly used in autoimmune conditions) and oral antibiotics, which can help in some individuals—especially when standard treatments are not effective.
Medications That Adjust the Immune System
For severe or stubborn lichen planus, doctors may prescribe drugs that lower or change how the immune system works, such as:
- Calcineurin inhibitors
- Immunosuppressive antimetabolites
- Anti-inflammatory agents
- Immunomodulatory agents
These medications come with specific risks and require regular monitoring. Doctors usually reserve them for cases that have not improved with other treatments.
Medicines for Itching (Antihistamines)
Doctors may recommend oral antihistamines to help reduce itching. People usually take these as pills to lower the urge to scratch and improve daily comfort.
| Antihistamine | How It Helps |
|---|---|
| Cetirizine | Reduces itching |
| Loratadine | Eases skin discomfort |
| Diphenhydramine | Helps with sleeping if itching is worse at night |
Therapy Using Light
Clinicians use phototherapy with controlled ultraviolet B (UVB) light 2–3 times per week to help with skin lesions. This treatment is not usually used for mouth or nail involvement. A possible side effect is changes in skin color after healing.
Treatments Using Vitamin A Creams or Tablets (Retinoids)
Doctors may prescribe retinoids as a cream or pill. These vitamin A-related medications can treat the skin or mouth. Retinoids are not suitable for those who are or may become pregnant because of the risk of birth defects.
Strategies for Managing Possible Triggers
When lichen planus may be linked to medicines, infections, or allergies, the health care provider will try to identify and address these triggers.
This might mean changing a prescription, testing for allergies, or treating infections. Addressing possible causes can help prevent symptoms from returning.
Practical Tips for Daily Care
People can manage lichen planus symptoms at home to improve comfort and well-being. Taking baths in lukewarm water with an oatmeal-based product may calm skin irritation and soothe itching.
After bathing, gently patting the skin dry and using a soothing moisturizer can help.
Applying a cool, damp cloth to itchy areas can also bring quick relief. When using over-the-counter hydrocortisone cream, make sure it has at least 1% strength and apply it only if no prescription corticosteroids are used.
Maintaining good oral hygiene, such as brushing twice daily and flossing, is important if the mouth is affected. Avoid scratching the skin to prevent nail injuries.
Managing stress, blood pressure, and blood sugar supports overall health and may help improve quality of life.
Complementary Treatments
Some people use aloe vera gel to help with itching and irritation linked to lichen planus, especially on the vulva and in the mouth.
Mind-body practices, such as deep breathing and yoga, may lower stress, as stress might make symptoms like pruritic rashes or dyspareunia worse.
Important To Note: People should check with a doctor before starting any herbal or alternative therapy, as some can have unwanted effects or might not be safe for those with candidiasis or a lichenoid drug eruption. This is especially vital for anyone at risk for carcinoma.
| Alternative Approach | Possible Benefits |
|---|---|
| Aloe vera | Soothes skin and mouth. |
| Stress reduction | Reduces the occurrence of symptom flare-ups. |
Getting Ready for Your Medical Visit
Steps You Can Take Ahead of Time
Preparing for an appointment helps patients get the most out of their visit, especially when dealing with possible skin conditions that might be linked to issues like hepatitis C infection or pemphigus. Here are a few tips to help:
- Write down all symptoms and note how long they have been present.
- Make a list of all medications, supplements, and vitamins currently being taken. Be sure to include the dose for each.
- Prepare questions for the health care team. Some examples include:
- What could be causing these symptoms?
- Could hepatitis C or another infection like HCV be involved?
- Are any tests needed to rule out other conditions such as pemphigus?
- What types of treatment are available, including options for possible hepatitis?
- Are there side effects to consider for each treatment?
- How should any other health problems be managed together with this condition?
- Will there be any restrictions or special instructions?
- Would a visit to a specialist be helpful?
- Are there cost-saving alternatives to the recommended medicines?
Tip: Bring copies of all test results or past medical reports related to symptoms or previous illnesses.
Questions the Doctor Might Ask
During the visit, the doctor may collect detailed information to help with diagnosis. They might ask:
- Where are the symptoms located on the body?
- Is there any itchiness or pain, and how severe is it?
- Have any new medicines or supplements been started recently?
- Has the patient received any recent vaccinations?
- Are there any known allergies?
- Has the patient ever had hepatitis C or any other liver diseases?
The health provider may also ask about any family history of skin or autoimmune conditions, and if the patient knows about any exposure to hepatitis viruses.
