Lichen Planus (cont.)

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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 because, under the microscope, lichen planus is distinctive in appearance.

Because there are a number of other lichenoid eruptions that to resemble lichen planus a biopsy confirmation is frequently necessary. 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. There seems to be a few patients in whom ulcerative lichen planus precedes the development of oral cancer.

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. Ultimately, there is no agreed upon cure for this condition.

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 when possible. 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. Oral medications may include a course of oral corticosteroids such as prednisone or metronidazole (Flagyl). Occasionally, other immunosuppressive agents may be employed. 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 be discontinued.

Medically Reviewed by a Doctor on 4/16/2014

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