Symptoms and Treatment of Lichen Planus

" Lichen planus is the name given to a chronic skin rash that resembles a plant that typically grows on tree barks and rocks (lichen) and has a flat (planus) top surface. It is a poorly understood recurrent type of skin rash that can also affect the nails, inside of the mouth and/or the vagina. The condition has a higher incidence in adults aged 30 to 60. Oral or mouth lichen planus occurs more often in women. The condition often clears on its own in under 2 years. Approximately 20% of people will experience another outbreak."  

What is Lichen Planus?

Lichen planus typically affects middle-aged adults. It is not as common in children. More women than men get the rashes in their mouths.

lichen planus
The Lichen Planus Skin Rash is characterized by flat topped pint to violet shiny papules
Source: Meisenheimer Clinic

What exactly causes lichen planus is unknown (idiopathic). However, it has been associated in some places with people who have been infected with hepatitis C. It has also been linked to the intake of certain drugs like quinidine or quinacrine (antimalarial),diuretics (drugs for heart diseaseand high blood pressure), and other medications containing bismuth, arsenic, or gold. Similar skin eruptions have also been known to occur in some bone marrow transplant patients. Dental fillings made of metal may cause lichenplanus to appear in the mouth, although this is rare. Others suspect that the condition may be an autoimmune disorder, but more studies have to be done.

A familial type of (bullous) lichen planusruns in families and the cause is not clear.

Lichen Planus Diagnosis

Physicians can often make a straightforward diagnosis of typical cases by simply examining the rash. However, askin biopsy may be needed to confirm the diagnosis.

There are a many skin eruptions that to resemble lichenplanus (lichenoid) and a biopsy can confirm the suspicious lesions. Persistent lesions in the mouth and vagina may resemble leukoplakia, which are precancerous white plaques. In a few patients, ulcerative lichenplanus may precede the development of oral cancer.

A Dermatologist might recommend blood tests to rule out other causes of any particular skin condition.

lichen planus skin bumps back
Chronic Case of Lichens Planus Symptoms on Back
Source: AAD

Lichen Planus Symptoms

Lichenplanus appears on the skin as flat-topped rashes, which are violet or lilac in color and measuring a few millimeters. They are usually found in the inner wrist, forearm, lower leg, and lower back. The itchy lesions have symmetrical sides with sharp borders and they can occur as a single lesion or in clusters.Skin lesions may later develop ulcers or blisters.

The condition can suddenly appear (acute) or slowly erupt on the skin over several weeks.

wrist lichen planus

Lichen Planus Symptoms on Wrist including Red/Purple Firm Skin Bumps
Source: AAD

A variant form, known as hypertrophic lichenplanus, appears thick, scaly, and reddish-brown in color. These are typically found on the shin and other body parts. These are especially persistent lesions that are very itchy. It is rare for the condition to appear on the scalp.

lichen planus symptoms

LichenPlanus Symptoms on Leg

Lichen Planus Mouth

Lesions in the mucous membranes (mouth and vagina) are also common. They appear as white, lacy rashes inside the cheeks or mouth. They may occur before the appearance of any skin rashes. Another variant that occurs as a troublesome sore is the erosive lichenplanus, a rare type of lesion that causes shallow, painful, and recurrent mouth ulcers.

The condition indicates a higher chance of getting oral cancer. Be sure to be screened for mouth and gum cancer 1x to 2x per year. Keep the mouth as clean as possible including 2x teeth brushing and nightly flossing. Visit a dentist every 6 months. Avoid caffeinated beverages, tomato based foods, spicy or acidic foods (fruits and fruit juice).

lichen planus mouth
LichenPlanus Mouth Symptoms are Small White Spots, Swelling, Gum Peeling and Sores
Source: AAD

Lichen Planus on Genitals and Vagina

When lichenplanus affects the genitals and the vagina,it may be confused with a sexually transmitted disease. However, lichen planus is neither contagious nor sexually transmitted.

lichen planus skin bumps
Lichen Planus Skin Bumps are Firm to the Touch
Source: AAD

LichenPlanus Nails (toenail or fingernail)

LichensPlanus can cause multiple symptoms on the nails including thinning, grooves or ridges, splitting and nail loss. The loss can be permanent or temporary.

lichen planus nails
LichenPlanus Symptoms on Nails Causes Nail Loss, Thinning, and Ridges
Source: AAD


Mild cases of lichenplanus do not need treatment. Treatment is directed at reducing symptoms such as pain and itchiness and at promoting the healing of lesions. If drugs are suspected as the cause, they may be discontinued with a doctor’s advice. To limit symptoms try to reduce personal stress and avoid itching or scratching the skin.

Treatments may include:

• oral antihistamines to reduce itching
• topical corticosteroids to reduce inflammation and itching, cyclosporine can induce rapid remission

lichen planus treatment

Hypertrophic LichenPlanus Treatment Using a Topical Ointment

• ultraviolet light therapy for persistent rashes (PUVA therapy) and when topical therapy does not work
• In severe cases, low dose oral steroids such as prednisone may be prescribed

Dressings may be applied to prevent scratching of lesions.

Mouth sores may be relieved with lidocaine (a local anesthetic) mouthwashes used before meals.

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References for Red Spots on Skin:

Cole, G. Lichen Planus.

AAD. LichenPlanus.

Medline Plus. 


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