Hearing about “lichen planus” might sound strange: how is it possible for it to grow on the human body? The “lichen planus” that grows on the human body is not the same as the “lichen” that grows on the ground! Listen to me as I explain it slowly.
What is lichen planus?
Lichen planus is actually a chronic inflammatory skin disease that primarily affects the skin, hair follicles, mucous membranes, fingers (and toes), with a prevalence in the population of 1.4% – 0.8%. The cause of this disease is unknown, but it could be related to immunological, genetic, viral infections, psychological and neurological factors, and more (sources from therapeutique-dermatologique.org ).
What are the symptoms of lichen planus?
Skin changes: Commonly localized on wrists, around ankles, inside thighs, and on the front of legs. Skin lesions often appear as flat, polygonal, red-violet papules, with white reticular streaks, a wax-like shiny surface, ranging in size from the tip of a pencil to a centimeter, which can be grouped or scattered, localized or widespread, accompanied by itching.
Changes in oral mucosa: The typical appearance involves slightly raised white streaks on the cheeks, intertwined to form a network or short radial elevations. Gums can be involved, manifesting as chronic desquamative gingivitis with evident peeling, swelling, and pain, sometimes accompanied by a feeling of discomfort to severe pain.
Changes in genital areas: Lesions similar to those on oral mucous membranes, ranging from clustered papules to severe ulcerative or erosive lesions.
Changes in fingernails (and toenails): Nail deformities, nail detachment, longitudinal grooves in the nails, wing-shaped hypertrophy, thinning, and even nail damage or detachment.
Hair changes: Hair thinning, hair loss, scalp peeling, with the presence of red-violet follicular papules and itching. In severe cases, permanent scarring hair loss can occur.
Manifestations of special types of lichen planus: Pigmented lichen planus mainly appears as blue pigmented deposits or brown spots on the face, neck, and upper back; vesicular lichen planus presents as a typical form of lichen planus but with blisters or bullae.
What are the risks associated with lichen planus?
Increased risk of cutaneous squamous cell carcinoma, especially in cases of ulcerative lichen planus that develops in the oral cavity, on the feet or genital organs, and in cases of hypertrophic lichen planus on the legs.
Lichen planus of oral mucosa can compromise the ability to eat, making the mucosa sensitive to stimuli, increasing the likelihood of oral inflammations, and severely affecting daily life.
Lichen planus of the ear canal, if not treated promptly, can lead to hearing loss.
How is lichen planus treated?
Currently, there is no specific cure for lichen planus, so an integrated therapeutic approach is often used. If the cause is known or if there are identifiable triggering factors, such as medications or chronic disease foci, it is important to promptly remove such causes.
Treatment modalities for lichen planus include: pharmacological treatment, physical treatment, photodynamic therapy.
Pharmacological treatment mainly involves the topical or oral use of corticosteroids, immunosuppressants, antibiotics, retinoic acid, and other drugs. Physical treatment includes laser therapy, cryotherapy, radiotherapy, and photodynamic therapy. Generally, surgical interventions are not necessary to treat this disease.
Chronic ulcerative lichen planus in the oral mucosa or vulva, or ulcerative lichen planus on the sole of the foot, increases the risk of cutaneous squamous cell carcinoma. Therefore, it is advisable to undergo prompt photodynamic therapy, with a frequency of once a week for 4-6 weeks.
Is it possible not to treat lichen planus?
This disease has a chronic progression, and if not treated promptly, although cutaneous lichen planus usually resolves spontaneously within 1-2 years, it can leave residual pigmentation; involvement of the oral mucosa can sometimes resolve within 5 years but often recurs; hair loss caused by lichen planus is permanent. Additionally, lichen planus has a prolonged duration, impacting the quality of life, mental health, the patient’s outward appearance, and in rare cases, it can evolve into carcinoma, posing a risk to the patient’s life (quotes from therapeutic dermatologique ) .
If treated promptly with regular care, it is possible to effectively control the disease, improve the patient’s quality of life and longevity, reduce scar formation, residual pigmentation, and reduce the risk of developing malignant tumors.
In summary, if lichen planus develops, it is essential to undergo active treatment!