Lichen planus is a condition that affects the skin, mouth, hair, genitals, and nails. This disorder usually presents on the skin as purple, flat, itchy bumps that develop gradually over a few weeks. In the genital areas and mouth, lichen planus appears as lacy white spots, which are sometimes accompanied by painful lesions.
Mild cases of lichen planus affecting the skin may not require treatment. However, prescription medications may be necessary if the condition causes intense itching or discomfort.
By Able Health I Medically reviewed by Dr. Alireza Estedlal
Page last reviewed: February 2024 I Next review due: February 2026
Lichen planus symptoms vary depending on the part of the body affected. Several nails are usually impacted by the condition. Some common symptoms include:
Lichen planus is likely caused by the immune system attacking mucous membranes or skin cells. The exact cause of this abnormal immune reaction is unclear, and the condition is not contagious.
Possible triggers for lichen planus include:
While lichen planus can affect anyone, it is more common in middle-aged adults. Women are at a higher risk of developing lichen planus in the mouth compared to men.
Treating lichen planus in the vagina and vulva can be challenging and may result in intense pain and scarring. Lesions in the genital area can also make intercourse painful.
Even after recovery, the affected nails and skin may remain somewhat darker. Oral lichen planus can interfere with eating and increase the risk of developing oral cancer. In rare cases, the condition can affect the ear canal, potentially leading to hearing loss if left untreated.
Your doctor will likely ask about your symptoms, review your medical history, and perform a physical examination to determine the underlying cause of your condition. Other diagnostic tests may include:
If you do not experience any discomfort or pain, treatment may not be necessary. Lichen planus on the skin often resolves on its own within months or years.
However, medications and other treatments can help alleviate itching, reduce pain, and speed up the healing process. Discuss the pros and cons of various treatment options with your doctor. In some cases, you may need multiple approaches to effectively manage the symptoms.
Treating lichen planus affecting the nails or mucous membranes can be more difficult, and symptoms may recur even after successful treatment. Regular follow-up care, at least once a year, is recommended.
The first line of treatment for lichen planus affecting the skin is usually prescription corticosteroid creams or ointments, which help reduce inflammation, pain, and swelling.
If topical treatments are not effective or if the condition is severe or widespread, your doctor may prescribe corticosteroid injections or tablets. Side effects vary depending on usage, but corticosteroids are generally safe when used as prescribed.
Other oral medications that may be prescribed for lichen planus include the antimalarial drug hydroxychloroquine or the antibiotic metronidazole.
For severe cases, medications that modify the immune response may be necessary. While these drugs have shown some effectiveness, further research is needed. Options include:
Oral antihistamines may help reduce skin itching triggered by lichen planus.
Light therapy (phototherapy) can be effective in clearing lichen planus on the skin. In this treatment, the affected skin is exposed to ultraviolet B light two to three times a week for several weeks.
A potential side effect of light therapy is post-inflammatory hyperpigmentation, which can cause long-lasting changes in skin colour after healing.
Retinoid medications, taken orally or applied to the skin, are another treatment option for lichen planus. Acitretin is a commonly prescribed retinoid.
However, retinoids can cause birth defects, so they are not recommended for pregnant women or those planning to become pregnant. Your doctor may advise delaying treatment or choosing an alternative if you are pregnant or breastfeeding.
If your doctor suspects that lichen planus is linked to an allergy, infection, medication, or other factors, additional tests or treatments may be necessary to address the underlying issue. This could involve changing your medication or undergoing further allergy testing.
Several self-care approaches can help relieve itching and discomfort caused by lichen planus:
Some small studies suggest that aloe vera gel may help with lichen planus of the vulva, while aloe vera mouthwash may be effective for oral lichen planus.
Additionally, managing stress through alternative approaches such as meditation may help as stress can exacerbate lichen planus symptoms.
Always consult your doctor before trying any alternative treatments, as some supplements or alternative therapies may cause adverse side effects.
You will likely start by seeing your GP. If lichen planus affects your skin, you may be referred to a dermatologist. If it affects the vulva or vagina, you may need to see a gynaecologist specialising in female reproductive health.
Before your appointment, make a list of the following:
Some basic questions about lichen planus that you might want to ask include:
During your appointment, your doctor may ask the following questions: