Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
"My dentist just diagnosed me with lichen planus after two medical doctors didn't know what it was. Both doctors gave me a viral cream, which didn't even touch it. When I first got this, it started with my lips swelling. Then I could feel little blisters forming on the inside bottom lip. Some formed inside my top lip as well. My bottom lip developed a deep ridge and was very raw to the point of bleeding. I was putting a triple antibiotic ointment on my lips at night hoping it would cure it. It only soothed it as did Vaseline. It lasts about three weeks when it comes. It will get better, and the ridge will go away, but it isn't gone very long when it begins again. I have to be careful and not burn my lips on hot food or beverages as this will set it off. My lips also will get very dry and don't seem to absorb any moisture from the Vaseline. The rash will also get on the outside rim of my bottom lip. There
isn't a cure, so the only thing I can do is to keep applying Vaseline and Blistex on my lips. Having lichen planus also affects the tip of my tongue, altering the taste of food. I have had it inside my cheek and on the side of my tongue, which is white and red with bumps."
Lichen planus is a chronic recurrent rash of unknown cause with no established cure.
Lichen planus generally affects adults and can involve any portion of the body, but
it has a predilection for the wrists, ankles, and oral and genital tissues.
Lichen planus can be quite itchy.
Lichen planus may spontaneously resolve.
Lichen planus is managed with a variety of topical and oral medications.
What is lichen planus?
Lichen planus is a chronic recurrent rash that is due to inflammation. The rash is characterized by small, flat-topped, many-sided (polygonal) bumps that can grow together into rough, scaly plaques on the skin. There may also be a rash in the lining (mucous membranes) of the mouth or vagina.
Lichen planus is a very curious and poorly understood skin condition. Its name is descriptive in that to some it resembles a simple plant, a lichen, that grows on rocks and tree bark, while
planus is Latin for flat.
What causes lichen planus?
The cause of lichen planus is unknown. In certain locales, patients with extensive lichen planus seem to be more likely to have a
hepatitis C virus infection of the liver. However, it is unclear if this virus is the cause of lichen planus in such situations.
Some drugs, such as those containing arsenic, bismuth, or gold, can produce an eruption which appears identical to lichen planus. Exposure to certain chemicals used in the development of color photographs can also produce a similar rash. The long-term use of the drugs quinacrine or quinidine (Quinidine
Gluconate, Quinidine Sulfate), which is used for malaria, certain microscopic organisms, and worms, may produce hypertrophic lichen planus of the lower legs and other skin and body-wide (systemic) disturbances. Lichenoid eruptions can occur in graft-versus-host disease in people who have received bone marrow transplants. Tissue examination by a pathologist (biopsy) would be necessary distinguish lichenoid drug eruptions from classical lichen planus, which is not caused by medication. Of course, stopping the offending drug is associated with resolution of the eruption.
How is the rash of lichen planus different from that of most
other common rashes?
Lichen planus can be distinguished from eczema, psoriasis, and other common rashes purely on the basis of its clinical appearance in that lesions are small bumps or aggregations of bumps that are flat-topped, shiny, polygonal, purple to grey in color, tend to occur at the wrists and elbows and ankles, and on close examination contain thin white lines called Wickham's
striae. When lichen planus involves the oral tissues, such as the lips or cheeks, these white filmy lines are easy to detect. It is not unusual for lichen planus to appear at sites of trauma, especially along lines of scratches (excoriations).
What are the symptoms and signs of lichen planus?
Lichen planus itches with an intensity that varies in different
people from mild to severe.
The onset of lichen planus can be sudden or gradual. The first attack may last for weeks or months, and recurrences may happen for years. The bumps at first are 2
mm to 4 mm in diameter, with angular borders and a violet color. An excess of pigment (hyperpigmentation) may develop in the affected skin as the lesions persist. Rarely, a patchy, scarring balding (alopecia) of the scalp occurs.
What does lichen planus look like?
The appearance of lichen planus depends on whether the skin or the
lining (mucous membranes) inside the mouth or vagina are affected:
Skin involvement: The usual skin involvement with lichen
planus consists of flat-topped lilac or violet spots a few
millimeters in diameter on the skin. These spots tend to be located
on the inner wrists, forearms, the lower legs just above the ankles,
and the lower part of the back.
A variant of this disease is called hypertrophic lichen
planus. This condition appears as thick, reddish-brown lesions
that are covered with scales. These spots tend to be on the shins,
but they can occur anywhere on the body. This is an especially itchy
and persistent (chronic) variant of lichen planus.
Mucous membranes: Lichen planus of the mucous membranes is common.
Dentists often come across it as a white, lacy rash on the inside of the
cheeks of people who are unaware of the condition. About half of the people
affected with lichen planus have the rash inside of their mouths (oral
mucosa). The oral rash often occurs prior to any skin involvement.
More troublesome, although rare, is erosive lichen planus,
which can be quite sore and uncomfortable. This erosive form
typically causes the patient to complain of the shallow and often
quite painful, recurrent ulcers in the mouth.
Lichen planus can affect the female genitals, including the
vagina. This condition can be confused with sexually transmitted
diseases (STDs), although lichen planus is neither sexually
transmitted nor contagious.
Sometimes, lichen planus produces pits and grooves in the nails as
well.
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
There are a variety of diseases and conditions that can cause tongue problems, discoloration, and soreness. Though most tongue problems are not serious. Conditions such as leukoplakia, oral thrush, and oral lichen planus may cause a white tongue while Kawasaki syndrome, scarlet fever, and geographic tongue may cause the tongue to appear red. A black hairy tongue may be caused by overgrown papillae on the tongue. Canker sores, smoking, and trauma may cause soreness of the tongue.
There are a number of things that can cause a whitish coating or white spots to develop on the tongue, including:
Leukoplakia. This condition causes cells in the mouth to grow excessively. That, in turn, leads to the formation of white patches inside the mouth, including on the tongue. Although not dangerous on its own, leukoplakia can be a precursor to cancer. So it is important for your dentist to determine the cause of white patches on your tongue. Leukoplakia can develop when
the tongue has been irritated and is often found in people who use
tobacco products.
Oral thrush. Also known as candidiasis, oral thrush is a yeast infection that develops inside the mouth. The condition results in white patches that are often cottage cheese-like in consistency on the surfaces of the mouth and tongue. Oral thrush is most commonly seen in infants and the elderly, espe...
