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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.



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