- Itching rashes - which may be mild to severe.
Lichen planus of the skin
Lichen planus of the skin is characterized by violaceous (reddish-purple), flat-topped bumps that may be very itchy. Some may have a white lacy appearance, in straight lines, called Wickham's striae. They can be anywhere on the body, but seem to favour the inside of the wrists and ankles. Lichen planus can also occur on the lower back, neck, legs, genitals, and in rare cases, the scalp and nails. Lichen planus on the legs is usually darker in appearance. There may be thick patches, especially on the shins. Blisters are rare, except in special cases. Another clue to the diagnosis is that lesions may occur in areas exposed to trauma, such as lacerations. This tendency is known as an isomorphic response, or Koebner's phenomenon. Lesions often resolve with intense hyperpigmentation. Some physicians describe lichen planus with the six, "Ps":pruritic, polygonal, planar (flat-topped),purple,papules and plaques. While some patients may be asymptomatic, most experience intense pruritus, a hallmark of lichen planus. While the typical appearance of lichen planus makes the disease somewhat easy to identify, a skin biopsy may be needed to confirm the diagnosis.
Lichen planus of the skin causes severe itching. As it heals, lichen planus often leaves a dark brown discolouration on the skin. These marks may eventually fade with time and treatment.
Lichen planus of the mouth
Lichen planus of the mouth most commonly occurs on the inside of the cheeks, but can affect the tongue, lips, and gums. Oral lichen planus is more difficult to treat. About 1 in 5 people who have oral lichen planus also have lichen planus on the skin.
Oral lichen planus typically appears as patches of fine white lines and dots. More severe forms of oral lichen planus can cause painful sores and ulcers in the mouth. A biopsy of the affected tissue may be needed, to confirm a diagnosis.
Patients with oral lichen planus may be at a slightly increased risk of developing oral cancer. It is wise to discontinue the use of alcohol and tobacco products, because of the increased risk. Regular visits to the doctor for an oral cancer screening is recommended.
Lichen planus of the genitals
Lichen planus of the genitals is less common in men than women. About 1 in 5 women have vulvar or vaginal lichen planus. It may cause red areas or open sores causing pain, especially with sexual intercourse.
Nail involvement
Nail changes have been observed in lichen planus. The majority of nail changes result from damage to the nail matrix, or nail root. Nail changes can occur with or without skin involvement.
Nail changes associated with lichen planus include longitudinal ridging and grooving, splitting, nail thinning and nail loss. In severe cases, the nail may be temporarily or permanently destroyed.
Scalp involvement
Lichen planus can affect hairy areas such as the scalp in rare cases. This is called lichen planopilaris and can lead to redness, irritation, and in some cases, permanent hair loss.
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