What is Lichen Planus?

Lichen planus (LP) is a persistent inflammatory condition affecting the skin and mucous membranes, with an estimated incidence ranging from 0.5% to 4.0%.

The classical presentation of this condition features characteristic purple, itchy patches appearing anywhere on the patient's body. To this day, its cause remains unknown.

Beyond the purple patches

Lichen planus is an autoimmune disease that begins when the immune system starts to go wrong. It identifies cells in the skin or mucous membranes as foreign invaders that infest the body. It tends to have a purple-coloured flat-topped appearance and frequently comes with intense itching. Most lesions occur at the wrists, lower back, or ankles, but can sometimes occur inside the oral cavity, under the nails, or skin of genital areas, causing frustrating symptoms. Lichen planus is more auto-inflammatory than most autoimmune diseases.

Lichen planus vs lichen sclerosus

Although they have similar general names, they are two different entities. Lichen planus usually occurs as purple, flat-topped bumps on most body areas. Lichen sclerosus is more often suggested by white patches.

This general difference would be in its appearance and distribution localisation features, which rarely involve the oral surfaces, whereas lichen planus may include oral surfaces, among others.

Who gets lichen planus?

This disease can affect anyone, although it does have certain patterns in its distribution. The most common age group of patients affected by this illness is middle-aged adults between 30 and 60. Anxiety or stress, some medications, and primary autoimmune diseases, if present, can precipitate an outbreak. Understanding the effects of anxiety on the body can also help explain how emotional stress may trigger or worsen physical symptoms in such conditions.

No family contribution occurs, but in a few instances, a person may be predisposed through a history of autoimmune diseases in their family towards the formation of lichen planus.

Signs and symptoms of lichen planus

The symptoms of lichen planus vary with the particular location of the lesions on the body, though they are generally purplish and flat-topped with fine white lines called Wickham's striae. They tend to group on the wrists, ankles, and lower back and are very itchy.

Oral lichen planus can be seen as white lacy patches inside the mouth, within the cheeks and tongue, and could be burning or sore. It causes ridging, thinning, and even nail loss. If it is present on the scalp, then there can be alopecia with scarring. Genital lichen planus is often very painful while having intercourse and other sexual activities.

What triggers lichen planus?

This phenomenon, known as a flare-up or exacerbation of symptoms, has numerous causes. Stress commonly triggers lichen planus; most patients will say that their condition worsens when they are stressed. Certain medications for hypertension or arthritis can precipitate a flare-up. Hazardous chemicals or environmental allergens can also act as triggers. Dental materials containing mercury, tobacco use, and certain foods may provoke oral lichen planus. For individuals managing joint-related conditions, understanding arthritis myths and facts can help distinguish between common misconceptions and medically accurate information, leading to better care and lifestyle choices.

Causes of lichen planus

Lichen planus is a chronic inflammatory condition that affects the skin, nails, hair, and mucous membranes. While the exact cause isn’t always clear, it is generally considered an autoimmune disorder, meaning the immune system mistakenly attacks the body’s own skin and mucosal cells. This leads to inflammation and the formation of characteristic purplish, itchy bumps or lesions. Several factors are believed to trigger or worsen the condition:

• Immune system dysfunction
  The primary cause is thought to be an overactive immune response, where white blood cells attack healthy skin or mucosal cells. This autoimmune reaction leads to swelling and irritation, resulting in the typical rash or lesions.
  
  
• Genetic predisposition
  People with a family history of autoimmune disorders or lichen planus may be more susceptible. Genetic factors can make the immune system more likely to overreact to triggers.
  
  
• Infections
  Some viral infections, particularly hepatitis C, have been linked to lichen planus. Chronic infection may stimulate the immune system and lead to the condition.
  
  
• Allergic reactions
  In some cases, contact with certain dental materials (like amalgam fillings), dyes, or chemicals may cause an allergic-type reaction that resembles lichen planus.
  
  
• Stress and emotional triggers
  Stress doesn’t directly cause lichen planus, but it can weaken the immune system and worsen flare-ups in people already prone to the condition. Following simple tips to boost the immune system—such as eating nutrient-rich foods, staying active, managing stress, and getting enough sleep—can help the body stay resilient and reduce the likelihood of flare-ups.

What are the types of lichen planus?

Lichen planus can appear in several ways on various parts of the body in different forms. Cutaneous lichen planus is the most common form. Oral lichen planus impacts the mucous membranes lining the mouth and causes white lacy patterns or painful ulcers. Nail lichen planus may result in nails that are permanently scarred due to ridging and splitting.

One type of lichen planus is at the hair follicle level and causes scarring alopecia. Hypertrophic lichen planus presents as raised, scaly plaques on the shin. Genital lichen planus involves intimate areas, and lichen planopilaris affects the scalp; both conditions require special treatment.

Home remedies for managing lichen planus symptoms

Other generalised self-management remedies for lichen planus can include some home treatments. Cold compresses sometimes soothe sore and itchy skin. Certain baths or medicated gels applied to lesions in the skin may also help relieve discomfort. Maintaining good oral hygiene will prevent oral symptoms. Meditation or other low-impact exercises can help control stress and minimise flare-ups. Incorporating proven stress management strategies—such as deep breathing, mindfulness, and gentle yoga—can further support emotional balance and skin health. However, one must not assume total responsibility for the medical management of this disease. It is strongly recommended to consult your nearest doctor for professional medical advice.

Path ahead

Once the patient knows the symptoms of lichen planus, triggers, and treatment, they can manage to improve their condition.

Most patients can be made to be at the helm of their disease if they are treated with an integrated approach of medical therapy, lifestyle modification, and adequate measures of self-care. Follow-up visits or communication with healthcare providers may offer optimal management of this chronic condition. Every case is unique; therefore, approaches for treatment should be individualised for the best outcome.

Frequently Asked Questions

1. What’s the difference between psoriasis and lichen planus?

Lichen planus symptoms present as purple-coloured flat-topped nodules with white lines; whereas psoriasis is characterised by thick red scaling patches. It often involves mucous membranes.

2. What are the complications of lichen planus?

Complications include scarring, permanent hair loss and nail damage, and an increased risk of oral cancer. Eating and speaking may be difficult with painful ulcers. Psychological effects are very common. If one has lichen planus, it is also recommended that one avoid certain foods and drinks. Avoid spicy, acidic, and salty foods, citrus fruits, and tomatoes. These foods will aggravate the lesions and symptoms. Soft foods should also be taken.

3. What can you expect if you have lichen planus?

Most people can recover in 1-2 years. Oral cases may persist longer. Follow-ups and lifestyle changes can be helpful. Flare-ups are possible at any time.