There are many health problems that can make your skin itch, including dryness, eczema, urticaria (hives), psoriasis and insect stings or bites. One of the causes of itchy, inflamed skin you may not have heard of, however, is lichen planus.
Like the itchy skin conditions mentioned above, lichen planus isn’t contagious. Strictly speaking it’s not painful either – though a lichen planus skin rash often causes mild to severe itching, which can be uncomfortable to say the least. And it can affect various parts of your body, even the inside of your mouth or your genitals. Some people can have symptoms in just one area, while others may have them in two or more parts of their body.
Lichen planus belongs to a group of inflammatory skin conditions called lichenoid dermatoses (or lichenoid skin disorders). These disorders are named after the lichen that grows on trees because of similarities in their appearance (the lichen planus rash, for instance, can look scaly with a flat top – in fact, the word planus means flat).
Around one in 5,000 people develops lichen planus, and while it can affect anyone at any age, you’re most likely to develop it if you’re aged 45 or older (i). It’s not very common, with up to one per cent of adults worldwide affected by cutaneous lichen planus (that is, lichen planus of the skin) (ii). Oral lichen planus (lichen planus of the mouth) is slightly more common, affecting up to four per cent of the population. Women may be more susceptible to developing lichen planus than men, with some studies claiming a male:female ratio of 1:1.5 (ii). Oral lichen planus, in particular, is thought to be more common in females (iii).
What causes lichen planus?
The truth is we don’t really know exactly what causes lichen planus. The rash develops when skin becomes inflamed, but nobody knows what causes the inflammation in the first place. However, the general belief is that the immune system is involved. One theory is that the immune system, possibly triggered by a virus or some other known or unknown factor, becomes overactive. This leads to immune cells called T cells attacking proteins in the skin, which causes inflammation. Because of this process, some say lichen planus is an autoimmune disorder (iv) – though others claim it isn’t, despite the fact that it’s similar to an autoimmune response (v).
Find out more about autoimmune conditions – that is, when the immune system mistakenly attacks normal, healthy tissues – in our guide What are autoimmune conditions?
Meanwhile there are a few known causes of rashes that are similar to that of lichen planus, though these happen very rarely. Some medicines, for instance, can cause rashes similar to lichen planus. These medicines include antimalarials, beta-blockers, anti-inflammatories, gold injections (also called disease-modifying anti-rheumatic drugs – or DMARDs – used to treat rheumatoid arthritis) and medicines mainly used to treat high blood pressure called thiazide diuretics (also called water tablets). When you get a rash from taking these medicines, it’s called a lichenoid drug eruption, and the rash will disappear gradually when you stop taking them.
Contact with chemicals used in photographic developing can also occasionally cause a rash that’s similar to lichen planus. Also, oral lichen planus can sometimes be caused by an allergy to mercury fillings in teeth.
Other things that may make you more vulnerable to developing lichen planus include:
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Skin injuries (including those caused by surgery)
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Some viral infections such as hepatitis C
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Stress (both physical and emotional)
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Vitamin D deficiency (this may be linked with oral lichen planus (iv)
Meanwhile the jury’s out on whether or not lichen planus runs in families, with – most experts claim your genes aren’t involved but others suggest up to 10 per cent of people with close family members who have lichen planus may develop it too (vi).
How long does lichen planus last?
According to the NHS, cutaneous lichen planus usually gets better on its own in around nine to 18 months (vii). In about one in five affected people the rash can recur again, with a small number experiencing lichen planus several times. However, if you have oral lichen planus the symptoms can last much longer, possibly for 10 years longer. Lichen planus of the genitals can also be more persistent.
A rare form of lichen planus – called erosive lichen planus – can cause symptoms for a long time too, and in some cases, it increases the risk of certain types of cancer (read on for more details).
What are the symptoms of lichen planus?
The symptoms of lichen planus vary according to the part of the body that’s affected, usually the skin, mouth or genitals:
Cutaneous lichen planus Any area of skin can be affected, though in most cases cutaneous lichen planus develops on the wrists, ankles, shins and lower back. Symptoms include:
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A rash made of small, firm, reddish purple bumps (papules) varying in size up to 1cm in diameter that are usually shiny and flat on the top. The top of the bumps can also have fine, irregular white streaks called Wickham’s striae. Some people with lichen planus only experience a few isolated bumps, though others can get many, sometimes grouped together and sometimes scattered around the body.
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Itching often accompanies the rash. Sometimes this is mild, but it can also be quite severe and affect your sleep and your general quality of life. According to Patient UK, people with cutaneous lichen planus tend to rub the rash, rather than scratch it (i).
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Bumps can be isolated, or they can clump together to form large patches. Each tends to last a few months, then fades (with new bumps often forming as older ones start to disappear).
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When the bumps fade they can leave behind brown or grey marks (pigmentation) that can take months or years to disappear.
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Sometimes the bumps can develop into blisters, though this is rare.
Variations of cutaneous lichen planus include hypertrophic lichen planus, which is often found on the shins and ankles where the rash is thickened and often very itchy. Ulcerative lichen planus is found on the soles of the feet and between the toes and can make walking difficult. Bullous lichen planus is most commonly found on the legs where bumps have developed into small to large fluid-containing blisters.
Oral lichen planus Lichen planus can develop inside the mouth, most often on the inside of the cheeks or on the tongue – though the gums and lips can also be affected – where it produces white streaks (often like a lacy pattern) or white patches. Since it isn’t itchy, mild oral lichen planus can go unnoticed until you have a routine dental check-up. Some people develop oral lichen planus on its own, though 50 per cent of those who have cutaneous lichen planus develop oral lichen planus too (i).
According to the Oral Health Foundation people with more moderate or severe oral lichen planus can also experience redness, ulcers or – very rarely – blistering on top of having white streaks/patches in their mouths (viii). If this happens, eating or drinking certain foods – including hot and spicy foods – can make your mouth burn and feel uncomfortable.
Lichen planus of the vulva and vagina The main symptom of lichen planus of the vulva and vagina is painless white streaks on the vulva. But it can also make parts of the vulva and the entrance to the vagina feel itchy, sore and uncomfortable, which – in severe cases – can make having sex difficult and painful. It can also cause scar tissue, which distorts the shape of the vagina, often making it narrower. Some women may also experience a sticky yellow or green discharge, which can be bloodstained.
Lichen planus of the penis If the penis is affected there may be purple or white ring-shaped patches on the tip (glans). Other symptoms include a rash with flat-topped, shiny, non-itchy bumps.
Lichen planus of the nails This can develop with or without cutaneous lichen planus. The symptoms include grooved and ridged nails – which are the result of the nail plate becoming thinner – as well as darkened or thickened nails that can sometimes lift off the nail bed. If the nail is destroyed, it won’t usually grow back. According to Patient UK, up to 10 per cent of people with lichen planus develop problems with their nails (ii).
Erosive lichen planus This is a rare type of lichen planus that causes long-term symptoms, usually painful ulcers in the mouth or on the genitals (though ulcers can also appear in other areas such as the eyelids or anus). Twice as common in women than in men (i), erosive lichen planus is thought to develop into certain types of cancer – including mouth, vulval and penile cancer – in around two per cent of those who develop it (ix).
There is also a form of lichen planus – called lichen planopilaris – that affects areas of skin with hair, most usually the scalp.
Are there any complications?
Skin pigmentation caused by faded bumps is the main complication of cutaneous lichen planus. Known as post-inflammatory hyperpigmentation, this comes in the form of grey or brown marks that can often last for several months. People with darker skin may experience more noticeable pigmentation than those with lighter skin.
People with lichen planus can also have a slightly higher chance of developing other inflammatory conditions than those who don’t have lichen planus. Examples of these conditions include ulcerative colitis, vitiligo and alopecia areata.
How is lichen planus treated?
There’s no immediate cure for lichen planus, but the good news is the rash will usually clear on its own in time. If your symptoms are mild you may not need any treatment at all. But if your symptoms are more bothersome and affect your quality of life there are several options you can try until the symptoms go away that can help relieve things like itching and discomfort, as well as improve how your skin looks.
For instance, your GP can prescribe creams and ointments to reduce itching and control the rash – these include steroid creams to reduce inflammation and emollient creams to help keep your skin hydrated. You can also take antihistamine medicines to ease itching – plus if the itching is affecting your ability to get a good night’s sleep, there are antihistamines that can help you feel drowsy (ask your GP to recommend the right type of antihistamines for your needs).
If, on the other hand, you have oral lichen planus with painful mouth ulcers, there are steroid pastes, sprays and mouthwashes that may be helpful, as well as mouthwashes that contain an anaesthetic to numb your mouth. Some people with oral lichen planus may also need to take a short course of steroid tablets.
People with severe lichen planus may need additional treatments such as steroid tablets or light therapy, while drugs called immune modulators can be prescribed by specialists in particularly severe cases. Laser treatments are also sometimes used to treat severe oral lichen planus.
How can you help yourself?
If you have lichen planus there are several things you can do yourself at home that will help you feel better and stop your symptoms getting worse. Here are some other things you could try to include:
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Try not to use soaps, shower gels or bubble baths as they may irritate your skin – just use plain warm (not hot) water. Also consider not washing your hair in the shower, as your shampoo may also irritate your skin (try washing it over your sink or bath instead)
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If you can, try not to scratch. You could try wearing cotton gloves while you’re in bed if you find you’re scratching in your sleep. Alternatively, if it’s possible, try covering your rash with a bandage to prevent scratching
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Take steps to reduce your stress and anxiety levels, as these may both can make lichen planus worse – take a look at our guide to stress symptoms and signs and anxiety symptoms for tips on destressing and feeling less anxious
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As well as avoiding hot and spicy foods, try staying away from acidic foods and drinks too if you have oral lichen planus (other things to avoid include sharp, crunchy foods and alcohol)
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Looking after your dental health can be beneficial if you have oral lichen planus – for instance, brush twice a day, floss once a day and see your dentist as often as they recommend (avoid mouthwashes with alcohol too, as they can irritate your mouth)
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Smoking can also irritate oral lichen planus – if you’re thinking of quitting there’s some helpful advice in our guide to stop smoking
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Avoid wearing tights or close-fitting clothes if you have lichen planus of the genitals
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If your genital area feels itchy and inflamed, placing an ice pack wrapped in a clean tea towel against the affected areas can bring some relief (if you don’t have an ice pack, wrap a bag of frozen peas in a tea towel instead)
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Also, if your genital area is affected, using a good-quality lubricant can make having sex more comfortable
Some nutritional supplements may also be helpful in reducing inflammation and pain, including:
High-strength fish oils The omega 3 fatty acids found in oily fish such as salmon, trout, herring, mackerel and fish oil supplements may also be useful in reducing inflammation (x), with researchers describing them as a useful side-effects-free alternative to conventional treatments (xi).
If you’re a vegetarian or vegan you can still benefit from an omega 3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega 3, which is sourced from plant organisms called microalgae rather than fish oils.
Turmeric A member of the zingiberaceae plant family, turmeric is often recommended by natural health practitioners for conditions that cause inflammation. As well as giving colour and flavour to curry dishes, it contains an antioxidant called curcumin. There is some evidence that extracts of plants belonging to the zingiberaceae family – including curcumin – are effective in managing discomfort (xii). Scientists also believe curcumin has anti-inflammatory effects (xiii).
PEA Short for palmitoylethanolamide, PEA is a type of fatty acid made naturally by the body and found in all cells, tissues and fluids including the brain (it’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk). Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (xiv), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to help manage discomfort and inflammation. However, researchers suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (xv) with no known side effects (xiv).
Your body naturally increases its production of PEA when your cells are damaged or threatened. But in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (xiv). When this happens PEA supplements may be helpful, with 16 clinical trials and meta-analysis of PEA suggesting it does help manage discomfort (xvi).
Magnesium An important mineral found naturally in the body; magnesium is needed for more than 300 biochemical reactions. It has also been studied in a variety of conditions associated with discomfort, with researchers finding it may be helpful (xvii) – though experts admit research is still at an early stage and more large-scale studies are needed to better understand how magnesium may help manage chronic discomfort.
Need more information?
If you want to find out more about a variety of skin conditions, the skin care section of our pharmacy health library provides lots of information and advice. There’s also a lot to discover about how the immune system works and how autoimmunity is involved in many different health conditions in our section on immunity.
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.
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