Cutaneous Lichen Planus
Is an inflammatory auto immune disease that affects the skin and mucous membranes. Cutaneous Lichen Planus presents with an itchy, non-infectious rash of small, pink or purple lesions, resembling a lichen plant.
Cutaneous Lichen Planus lesions can come in varying forms from ring shaped lesions to papules, pigmentations, rashes or bulle. It can be associated with other skin conditions such as lupus or sclera derma.
Cutaneous Lichen Planus effects the skin, scalp and nails, where as the Mucosal Lichen Planus effects the inside lining of mucous membranes of the gastrointestinal tract, genitals, bladder, ears, nose and eyes.
Unfortunately Cutaneous Lichen Planus has no cure, so maintenance of the skin condition is controlled with medication, emollients and other procedures.
Cutaneous Lichen Planus is a rare condition that affect 0.1 – 4% of people, predominantly females. Most cases are between 30 and 60 years of age, but it can occur at any age.
Causes of Cutaneous Lichen Planus:
- Unknown, however it is not contagious and does not involve any known pathogen.
- Thought to be a T- cell mediated autoimmune reaction (where the body’s immune system targets its own cells), which leads to the death of the epithelial (skin) cells.
- May be stress related.
Triggers may include:
- Drug reactions, (i.e. thiazide diuretics, gold salts, antimalarials, beta blockers, furosemide, anti-inflammatory’s, metformin, spironolactone and penicillamine).
- Mercury tooth fillings, where symptoms generally resolve with removal.
- Conditions such as, hepatitis, (specifically hep B and C infection), and primary biliary cirrhosis.
Symptoms of Cutaneous Lichen Planus:
- Rash appears abruptly, with the first outbreak usually lasting weeks to months.
- Recurrence of outbreaks can last for years – but are more common in Mucosal Lichen Planus than Cutaneous Lichen Planus.
- When the rash has gone there may be dark brown/gray spots on the skin, which are more noticeable on dark skin.
- 10% of cases effect the nails, causing irregular longitudinal grooving, ridging, thinning and shedding of the nail plate with tissue death of the nail bed.
- Hardening of skin under the nails and pigmentation may be evident.
- Papules are approximately 3mm to 5mm in diameter.
- White streaks on the papules, called “Wickham’s striae” can be present.
- Intense itching, especially at night.
- Most effected areas are the wrists, elbows, lower back and ankles.
- The shins present with hypertrophic (thickened) lichen planus.
- Scalp can be scaly and/or inflamed hair follicles which may scar.
- Condition may become worse with sunlight.
Diagnosis of Cutaneous Lichen Planus:
The diagnosis of Cutaneous Lichen Planus is clinically by the “lichen-like” appearance of the skin lesions. A biopsy can be used to rule out malignancies, and confirm diagnosis.
Treatment for Cutaneous Lichen Planus:
Cutaneous Lichen Planus has no cure so treatment is to relieve symptoms and cosmetic concerns until the rash clears.
- Corticosteroids and immunosuppressant topical ointment and removal of any triggers is usually the first line of treatment.
- Oral corticosteroids (steroid tablets) – for more severe cases, or when creams and ointments are not effective enough.
- Antihistamines, mainly at night to help with itching.
- Cosmetic treatments may include laser surgery, cryotherapy, and phototherapy.
- Ciclosporin capsules or acetretin tablets to lower the immune system, in severe cases.
Lichen planus due to its rare nature may go undiagnosed. Well Heeled Podiatry are trained and skilled in diagnosing many conditions on the feet. If you have an unusual rash or concern on the feet, make sure you have it checked by a professional to get the right treatment plan.