Lichen Planus
New treatment for oral lichen planus now available, using a special oral adaptor with the Exsys 308 Excimer Light – see pictures below.
Cause
The cause of Lichen Planus is unknown in the majority of individuals. In a small proportion of patients, however, the following causes can be traced.
- Medicines: the most common being some high blood pressure tablets, and remedies for diabetes, joint pains and TB. (See below for list of drugs causing lichen planus). For this reason, always provide a full list of medicines you have taken prior to the onset of your rash.
- Paraphenelenediamine. This is a chemical found in photographic chemical developer.
- Bone marrow transplantation. This is a very rare procedure performed for unusual disorders.
Appearance
small raised bumps (pinhead to 4mm in diameter)
purplish colour
many sided (polygonal)
smooth topped
shiny
itchy
The bumps may have whitish lines called Wikham’s striae.
Typical sites:
wrists
lower back (sacrum)
around ankles
inside the mouth
nails (typical appearance is called a pterigium)
On lower legs, spots may be larger and thickened.
Features at special sites:
1. the mouth: Whitish or purplish streaks may be seen on the inner aspect of the cheeks or lips. Ulceration (breaking down of the surface) at this site should always be reported to your dermatologist as there is a 1% chance of malignancy when this happens. In the early stages, this complication is curable.
2. the scalp: Patches of hair loss may be seen. This underlying skin retains its characteristic purplish colour.
3. the nails: the surface of the nails may become irregular with streaks running along the length of the nail or across the nail. A characteristic deformity which occurs almost solely in Lichen planus is called a Pterygium, in which the skin around the nail becomes continuous with the floor of the nail (nail bed). The actual nail is lost over this affected area. See picture above.
4. Genitalia: In males, the head or shaft of the penis and in females, the vulva or labia may be involved.
Lichen Planus is not a contagious disease. It is not transmitted from one person to another by contact or by sharing utensils, towels, clothing etc. In some individuals it is made worse by sun exposure. Stress tends to aggravate the condition but is not responsible for causing the eruption.
Treatment
The treatment of Lichen Planus is symptomatic. A cure has not as yet been discovered. Untreated, the rash often goes on for more than a year, but eventually subsides spontaneously. The purpose of treatment is to suppress the rash a lot sooner. It is not unusual for the rash to heal with very dark pigmentation, especially in pigmented individuals.
1. Topical corticosteroids
Popularly referred to as “cortisone creams”. Reasonably strong creams or ointments are used. On the genitalia, however, one has to exercise caution with the use of very strong steroids.
Examples of steroids used on the skin include Diprosone, Betnovate, Synalar, Nerisone, Elocon and Advantan. Very strong steroids include Dermovate, Diprolene and Nerisone Forte Fatty Ointment. The latter group should be reserved for very resistant, thick areas of involvement such as on the legs. One should never loose sight of the side effects of these preparations.
2. Intralesional steroids
This modality implies the injection of steroid preparations into individual spots. Only those areas resistant to topical steroids are treated with this regime. The legs are a favourite site for this form of treatment.
3. Oral steroids
In view of the nature of side effects associated with internal use, this route of administration is reserved only for very severe Lichen Planus affecting large areas of the body .
4. Etretinate (Tigason)
This very expensive medication, also with many side effects, has been used successfully in patients with extensive Lichen Planus.
5. Cyclosporin
The contents of the Cyclosporin capsule is dissolved in water and the mixture is swished around the mouth for about 5 minutes but not swallowed. This is excellent for lichen planus of the mouth.
6. Very mild Lichen Planus may of course be left alone until spontaneous resolution takes place
7. Oral Antihistamines
These may be used to relieve the associated itching.
Examples include Aterax, Tinset, Phenergan, Zyrtec, Clarityne, Telfast and Kestine.
The last four do not induce drowsiness.
8. Metronidazole tablets.
More recently metronidazole has been hailed as an excellent treatment for Lichen Planus. Our use of this product has produced results equivalent to those reported in the American Academy Journal. This medication is taken orally and takes about one to three months to achieve control of the condition.
9. Excimer laser
Recently the excimer laser has been found to be particularly beneficial for the treatment of lichen planus. Small areas of involvement are ideally suited to this form of treatment. A novel oral adaptor has been developed by GME (Germal Medical Engineering) which allows the oral mucosa (inside of the cheeks, gums, tongue, palate etc) to be treated.
Get a free online consultation
For online consultations, please phone 079 562 3251
Visit our facility
Suite 202, Westville Hospital, 7 Spine Road (now Harry Gwala Road), Westville, 3630, South Africa
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