Lichen planus is a common disease. It is very uncommon and the exact cause is still a mystery. Middle-aged adults are most commonly affected by this condition. Lichen planus can affect many body parts. This disease can affect the skin, oral cavity, genitals, scalp, oesophagus, and nails. Lichen planus has different names depending on the sites involved. Cutaneous lichen planus if the skin is involved, oral lichen planus if the oral cavity is involved, penile lichen planus if the penis is involved, vulvar lichen planus if the vulva is involved, lichen planopilaris if scalp is involved. Treatments for lichen planus in Kuala Lumpur are available to help fight against this disease.
Cutaneous lichen planus affects less than one per cent of the population. Cutaneous lichen planus affects individuals age 30 to 60 years old most of the time. The exact underlying cause is still unknown. However, there is a hypothesis which believes that immune-mediated mechanism involving T cells act against keratin producing cells or also known as basal keratinocytes. There is still not enough evidence to establish a correlation between hepatitis C infection with the development of lichen planus. The clinical features of cutaneous lichen planus are:
- Skin lesions
- Purple coloured lesions
- Itchy lesions
- Skin lesions appear as plaques
- Wickham’s striae
- Koebner reaction upon scratching
Cutaneous lichen planus usually affects the extremities especially ankles and wrists. This type of lichen planus can also affect the trunk and other body parts. Cutaneous lichen planus has few variants. The variants are:
- Hypertrophic lichen planus
- Annular lichen planus
- Bullous lichen planus
- Actinic lichen planus
- Lichen planus pigmentosus
- Inverse lichen planus
- Atrophic lichen planus
- Lichen planopilaris
- Palmoplantar lichen planus
- Perforating lichen planus
Diagnosis of lichen planus can only be made after a thorough history taking, physical examination, and investigations. Complete history taking and physical examination are important to analyze signs and symptoms. Adequate signs and symptoms analysis will help doctors to choose the appropriate investigations. The investigations to confirm the diagnosis of lichen planus is:
- Skin biopsy
- Dermoscopy
- Investigations to detect hepatitis c infection
Other diseases that may be mistaken with lichen planus are:
- Lichenoid drug eruption
- Chronic graft-versus-host disease
- Psoriasis
- Atopic dermatitis
- Lichen simplex chronicus
- Subacute cutaneous lupus erythematosus
- Discoid lupus erythematosus
- Secondary syphilis
- Pityriasis rosea
- Prurigo nodularis
Data has shown that lichen planus patients are more likely to suffer from dyslipidemia and thyroid disease. After a diagnosis is confirmed, treatment can be given. Cutaneous lichen planus most of the time is a self-limiting disease. The aim of treating cutaneous lichen planus is to accelerate recovery and to reduce itchiness. The treatments for cutaneous lichen planus are:
- Topical corticosteroids
- Intralesional corticosteroids (injection of triamcinolone)
- Oral corticosteroids
- Ultraviolet B phototherapy
- PUVA
- Oral retinoids
- Oral antihistamines
- Methotrexate
- Thalidomide
- LMW heparin
- Griseofulvin
- Cyclosporine
- Dapsone
- Sulfasalazine
- Metronidazole
- Hydroxychloroquine
Genital lichen planus can be treated with topical corticosteroids or topical calcineurin inhibitors. Treating lichen planopilaris can be challenging and difficult. Topical corticosteroids or intralesional corticosteroids are the main treatment. The first-line treatment for oral lichen planus is topical corticosteroids. Treatments for lichen planus in Kuala Lumpur are available to help fight against this disease and to help you achieve cure.