Lichen planus is an inflammatory skin condition that causes an itchy rash. It can affect the skin, nails, scalp, genitals and the inside of the mouth, though the skin is the most commonly involved site. This guide covers its causes, types, symptoms, diagnosis and treatment, and is for general information only—always consult a doctor for diagnosis and care.

Causes and Triggers

The exact cause is unknown, but it involves the immune system: T cells mistakenly attack healthy skin or mucous-membrane cells. Recognised triggers include:

Hepatitis C infection in some people.
Certain medications, such as some used for blood pressure, diabetes, heart disease and malaria.
Dental fillings, through allergic reactions to metals (especially oral lichen planus).
Stress and skin trauma, which may trigger or worsen flare-ups.

There may also be a genetic predisposition, and it most often affects middle-aged adults. Lichen planus is not contagious.

Types of Lichen Planus

Cutaneous: the most common type—flat, violet, polygonal papules with fine white streaks (Wickham's striae), often on wrists, ankles and lower back.
Oral: lacy white patches inside the mouth, sometimes with painful sores.
Nail: thinning, ridging, pitting, discolouration and occasional nail loss.
Lichen planopilaris (scalp): patchy hair loss that can be permanent.
Genital: bright red, painful erosions and possible scarring.

Symptoms

The most prominent symptom is itching, ranging from mild to severe. On the skin you may see purple-red, flat, itchy bumps with white streaks and, occasionally, thicker scaly patches or erosions. Nails can thin and ridge, the scalp may become sore with hair loss, and the mouth or genitals can develop white patches, sores or painful erosions.

Diagnosis

Diagnosis usually starts with a medical history and physical examination, looking for characteristic features. A skin biopsy often confirms it, while blood tests (for example to check for hepatitis C) and a KOH scraping for oral cases help rule out other conditions. Self-diagnosis isn't recommended, as other skin conditions can look similar.

Treatment

There is no cure, but treatment manages symptoms and prevents complications, tailored to severity and location:

Mild cases: topical corticosteroids, soothing emollients and antihistamines for itch.
Moderate to severe: oral corticosteroids, calcineurin inhibitors, light therapy or retinoids.
Oral and genital: targeted topical steroids, steroid injections, and immunosuppressants in resistant cases.

Gentle skincare helps day to day. Choose products for sensitive skin, soothe irritation with aloe vera or panthenol, and use a daily sunscreen, since sun can trigger some forms.

Final Thoughts

Lichen planus is not life-threatening, but it can affect comfort and quality of life. With early diagnosis and personalised care, its symptoms can be managed effectively. Always consult a qualified healthcare professional for diagnosis and treatment. For dermatology care, book at Skin Clinic, Lahore.