Lichen Planus (cont.)
How is lichen planus diagnosed?
Usually, lichen planus is relatively straightforward to diagnose.
Physicians can make the diagnosis in typical cases simply by looking
at the rash. If necessary, a skin biopsy may be done to help confirm
the diagnosis. Under the microscope, lichen planus is distinctive in
appearance.
This tell-tale appearance under the microscope can be valuable in
ensuring that the rash or spots are lichen planus. Persistent oral or
vaginal lichen planus, with spots that thicken and grow together, can
sometimes be difficult to distinguish clinically from whitish
precancerous plaques called leukoplakia. A biopsy can be helpful in
this situation.
Widespread lichen planus with erosions in the mouth can also be
confusing. A biopsy may be required to distinguish this from other
conditions such as candidiasis (yeast infection), carcinoma (cancer),
and ulcers in the mouth (aphthous ulcers).
What causes lichen planus?
In most cases, the cause of lichen planus is unknown.
Some drugs, such as those containing arsenic, bismuth, or gold can
cause a reaction that is indistinguishable from the rash of 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 (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. Other unusual causes of lichen planus
include liver disease and what is called graft-versus-host disease in
people who have received a transplant.
What is the treatment for lichen planus?
Most cases of lichen planus are relatively mild. Affected
individuals who do not have symptoms do not need
treatment.
If the itch or appearance of the rash are unpleasant, topical
corticosteroid creams may be of help. Topical steroid creams that,
for example, are under wrapping or taped at bedtime may also be
useful. For localized, itchy, thick lesions, injections of
corticosteroids may be given. Antihistamines may blunt the itch,
particularly if it is only moderate. This effect is in part due to
the sedative effect of antihistamines.
In more severe cases, physicians may recommend oral medications or
therapy with ultraviolet light. Orally taken medications may include
a course of oral corticosteroids such as prednisone. However, the
itching may return after the drug has been discontinued. A low-dose
oral corticosteroid every other morning may be also prescribed. With
continued itching, ultraviolet light (PUVA) treatment may help. For
painful lesions within the mouth, the use of special mouthwashes
containing a painkiller (such as lidocaine) before meals may provide
some relief. Any drug or chemical suspected of being the cause of the
lichen planus should of course also be halted.
Next: What is the long-term outlook for patients with lichen
planus? »
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