Lichen Planus Care
A comprehensive guide to lichen planus: causes, symptoms, types, and treatment and beauty solutions
A comprehensive review of the nature of lichen planus disease, its effects on skin and hair aesthetics, and clinical control and treatment protocols.
But what is the plan?
Lichen Planus is a common chronic inflammatory disease of the skin and mucous membranes that is rooted in an imbalance in the body's immune system. In this disease, T lymphocytes of the immune system attack the cells of the basal layer of the skin or mucosa for unknown reasons, creating specific lesions with unique clinical features.
This condition is completely non-contagious and has no connection to contagious bacterial or fungal infections; however, due to severe itching, the appearance of colored spots, hair involvement, and involvement of nails and oral mucosa, it has profound psychological and cosmetic effects on the quality of life of sufferers.
Causes and triggering factors
The exact cause of this autoimmune reaction is still not completely clear, but clinical evidence suggests that a combination of genetic and environmental factors are involved in its occurrence:
1. Autoimmune and genetic disorders
The misdirected attack of self-T cells on proteins in epidermal skin cells is the main trigger for the onset of inflammation, and a familial tendency is seen in some individuals.
2. Severe stress and nervous tension
Acute and chronic anxiety are considered one of the most powerful triggers for the onset of clinical attacks or recurrence of skin and mucosal lesions.
3. Taking certain medications
Lichenoid drug reactions caused by antihypertensive drugs (beta blockers), antimalarial drugs, nonsteroidal anti-inflammatory drugs, and gold salts can produce lesions resembling lichen planus.
4. Concurrent viral infections
A significant association between hepatitis C virus infection and oral lichen planus has been documented in a number of scientific studies.
5. Koebner Phenomenon
Any physical trauma, constant abrasion, scratching, and surgical incision can cause new lichen planus lesions to form exactly along the line of skin damage.
Clinical types of lichen planus
🟣 But skin plan
The most common form with itchy purple papules, mostly on the flexural surfaces of the wrists and feet and back.
👄 Oral lichen planus
White, lace-like lines (Wickham striae) on the cheek mucosa and gums, sometimes accompanied by painful sores and burning.
💇 Lichen Pilaris (follicular)
Involvement of hair follicles, which, if not treated early, leads to scarring alopecia and irreversible hair loss.
💅 But the nail plan
Thinning, longitudinal splitting, furrowing, and in severe cases, complete loss of the nail plate of one or more nails.
⚡ Lichen planus pigmentosus
Dark brown or gray macules, usually on sun-exposed areas such as the face, neck, and creases, without severe itching.
🩹 Hypertrophic lichen planus
Raised, thick, scaly, and extremely itchy plaques that generally appear on the front of the leg.
Key signs and skin symptoms
In classical dermatology, the main characteristics of lichen planus papules are known as the five P's :
- Pruritic: The itching is often very severe and debilitating, although instead of scratching with the fingernails, patients usually rub the area.
- Polygonal: The lesions are not round and have irregular polygonal margins.
- Purple/Violaceous: The distinctive color of the lesions ranges from dark pink to purplish purple.
- Planar: The upper surface of the papules is flat and shiny.
- Papules: Small, firm skin bumps between 2 and 10 mm in size.
In addition to these characteristics, fine white net lines called Wickham's Striae can be seen on flat lesions with a magnifying glass, which is a hallmark of this disease.
The effects of lichen planus on beauty and appearance
Although lichen planus does not involve deep vital organs, its superficial lesions pose several challenges:
- Post-inflammatory hyperpigmentation (PIH): After the inflammatory phase has subsided, persistent dark brown or smoky spots remain on the skin for months or years.
- Permanent hair loss on the head and eyebrows: The lichen planopilaris form destroys the hair follicle stem cells, creating flat, shiny bald areas without hair follicles.
- Nail deformation and deformity: prominent grooves, unevenness, and loss of aesthetic appearance of the hands and feet.
- Loss of self-confidence and social anxiety: The visibility of plaques on the hands or face and the remaining dark spots have a negative impact on personal relationships and the individual's mental image.
Comparative table of different forms of conflict
| Type of conflict | Common place | Main clinical complication | Risk of permanent scarring | Treatment priority |
|---|---|---|---|---|
| Classic cover | Wrist, ankle, waist | Very severe itching | Lower (mostly pigmented spots) | Control itching and inflammation |
| Oral erosion | Cheek mucosa, tongue, gums | Burning sensation when eating and talking | Medium to high | Topical corticosteroid and tissue monitoring |
| Lichen pilaris | Scalp, eyebrows | Hair loss and follicular fibrosis | Very high (scarring alopecia) | Urgent control to preserve the follicle |
| Nail | Fingernail and toenail fungus | Thinning and longitudinal cracking | Above (loss of shells) | Intralesional and systemic injection |
| Pigmentosis | Face, neck, body folds | Diffuse and resistant darkening | No scars (deep pigmentation) | Inhibition of melanin production and sunscreen |
Definitive diagnosis methods
Initial diagnosis is based on a careful clinical examination and examination of the specific appearance of the lesions; however, the use of the following methods is essential:
1. Dermoscopy
Non-invasive examination of the lesion with magnification that reveals Wickham's striae and vascular patterns without the need for skin incision.
2. Skin Biopsy and Histology
Punch biopsy and pathological examination are the gold standard for diagnosis. Observation of banded lymphocytic infiltration in the upper dermis and vacuolization of basal layer cells confirms the diagnosis.
3. Direct Immunofluorescence (DIF)
In cases of suspected autoimmune blistering diseases or lichen planus pemphigoid, it is performed to rule out other diagnoses.
New approaches to clinical treatment
The goal of medical treatment is to suppress the inflammatory response, relieve itching, and prevent permanent tissue damage:
Topical and injectable corticosteroids
High-potency corticosteroid ointments and creams are the first-line topical treatment. In thick hypertrophic plaques or focal alopecia, direct injection of triamcinolone deep into the lesion provides rapid results.
Topical calcineurin inhibitors
Drugs such as tacrolimus and pimecrolimus, without the thinning side effects of corticosteroids, are an excellent choice for sensitive lesions of the face, eyelids, and oral lichen planus.
Systemic and immunosuppressive drugs
In cases of extensive and progressive involvement, the doctor may use short-term oral corticosteroids, acitretin, methotrexate, mycophenolate mofetil, cyclosporine, or dapsone.
Light therapy (phototherapy)
The use of narrowband UVB radiation is a very safe and effective option for patients who have widespread involvement over a large area of the body's skin.
JAK inhibitors (New Horizons Therapy)
Janus kinase inhibitors, such as tofacitinib and baricitinib, are among the latest advances in targeted medicine that have shown promising results in cases of treatment-resistant lichen pilaris and lichen planus.
Solutions for repairing blemishes and scars caused by injuries
After the active phase of the disease has completely subsided, the appearance of the disease can be improved with careful monitoring:
Treatment of post-inflammatory hyperpigmentation (PIH)
Using anti-blemish creams containing azelaic acid, tranexamic acid, vitamin C, kojic acid, and mild retinoids can help gradually lighten melanin deposits. Very mild chemical peels can also be performed under a doctor's supervision.
Serious caution about lasers and deep peels
Invasive procedures such as ablative lasers, rough microneedling, or hair lasers are absolutely prohibited in the active phase due to the Koebner phenomenon , as thermal or mechanical shock will cause the disease lesions to relapse.
Hair transplantation in silent lichen pilaris
Hair transplantation is only permitted when the disease has been completely silent for at least one to two consecutive years and no signs of active follicular inflammation are seen in a repeat biopsy.
Lifestyle, nutrition and personal care
- Anxiety management: Breathing exercises, yoga, and relaxation techniques play a significant role in controlling relapse phases.
- Avoid scratching and abrasion: Avoid rough fabrics, woolen clothing, or tight synthetic fibers that rub against the skin;
- Continuous use of moisturizers: Restorative lotions and balms that are free of fragrance and essential oils restore the skin's defense barrier and reduce itching;
- Definite protection from sunlight: Physical (mineral) sunscreens prevent the aggravation of dark spots and photosensitivity;
- Gentle oral hygiene: In case of oral involvement, it is essential to avoid toothpastes containing SLS, spicy foods, spices, sour citrus fruits, and alcohol.
Frequently Asked Questions
Is lichen planus contagious or infectious?
Not at all; however, lichen planus is a type of internal autoimmune inflammatory reaction and is not transmitted to another person through physical contact, personal items, swimming pools, or close relationships.
How long does lichen planus last and does it heal on its own?
The classic cutaneous form fades away in most people within one to two years, although the dark spots may persist longer. The oral and hairy (pilaris) forms tend to have a more chronic course and require long-term monitoring.
Is hair loss caused by lichen pilaris reversible?
Unfortunately, hair whose follicles have been destroyed and fibrosed by inflammation will not regrow. Therefore, prompt and emergency diagnosis and treatment are vital to preserve the remaining follicles.
Is it permissible for people with lichen planus to get tattoos, microblading, or piercings?
No; due to the Koebner phenomenon, any type of skin piercing or tattoo can cause new itchy and destructive lesions to appear exactly in the area of the tattoo or piercing and is strongly discouraged.
Is there a link between lichen planus and skin or oral cancer?
Cutaneous lichen planus is usually benign in nature, but chronic ulcerative and erosive forms of oral lichen planus require regular periodic visits to assess any abnormal cellular changes in a timely manner.
Conclusion
Lichen planus is one of the most challenging but manageable inflammatory diseases of the skin and mucous membranes. The key to successful control of this disease lies in early diagnosis, initiation of targeted drug therapy to protect the skin and hair, avoidance of trauma and manipulation of the lesions, and patient management of pigmentary complications .
By carefully following the dermatologist's recommendations and taking basic care of the skin's defense barrier, a large portion of clinical symptoms will be controlled and the health and vitality of the person's appearance will be best maintained.
We are with you and answer to you.
Contact our experts for expert advice or to book an appointment quickly.
Do you need guidance or an appointment ?
Our experts are ready to serve you instantly and directly.
Contact us directly
To connect with the desired section, click on the relevant option.