Lichen Planus: Causes, Symptoms, Clinical Types, and Treatment

Lichen plan is a chronic inflammatory condition that can affect the skin, mucous membranes, nails, and in some cases, the scalp. It manifests through the appearance of characteristic, typically itchy lesions, which can have a variable impact depending on their location and severity. Although it is not contagious and does not spread through direct contact, this dermatological disorder can negatively impact quality of life, especially when it affects sensitive areas such as the oral cavity or the genital region. In its cutaneous forms, the rash tends to resolve spontaneously, but treatment is often necessary to control symptoms and prevent recurrence.

In this article, we will detail the possible causes, clinical manifestations, forms of evolution, and therapeutic options available for lichen plan.

What is Lichen Plan (“Lichen Planus”) and How Does it Manifest?

Photo Source: Shutterstock.com

Lichen plan is a chronic, immunologically mediated lichenoid dermatosis characterized by the appearance of polygonal, violaceous, shiny papules, primarily affecting areas such as the wrists, forearms, ankles, or lumbosacral region. This inflammatory condition affects not only the skin but can also involve the oral and genital mucosa, nails, and scalp, with each location having its own clinical and evolutionary peculiarities.

The pathogenic mechanism involves an aberrant T-cell response, which mistakenly identifies basal keratinocytes as “foreign,” triggering an inflammatory process focused at the dermo-epidermal junction. Although not an autoimmune disease in the classical sense, the persistent immune activation directed against its own structures suggests an immunological dysregulation component. The exact cause remains unknown, but predisposing factors such as stress, hepatitis C virus infection, and certain medications have been identified.

Lichen Plan – Clinical Manifestations and Functional Impact

Clinical manifestations vary depending on the location and severity. Cutaneous lesions present as well-defined papules, often accompanied by intense itching, a symptom that can significantly interfere with sleep and quality of life. In mucosal forms, such as oral lichen planus, whitish, reticular plaques may appear, sometimes painful, located on the inner cheeks, tongue, or gums. In more advanced stages, erosive lesions can form, with the potential for bleeding and increased discomfort during chewing or speaking.

For example, a suggestive clinical sign for this pathology is the presence of Wickham’s striae – thin, whitish lines forming a reticular pattern on the surface of the papules, most visible during dermatoscopic examination or in oblique light.

In cases with significant inflammatory symptoms, patients may benefit from adjuvant support with natural anti-inflammatory substances that aim to regulate the immune response. One such example is Liposomal Curcumin, a supplement formulated for optimal absorption, containing curcumin in a liposomal form with increased bioavailability. Through its documented action of inhibiting pro-inflammatory cytokines, curcumin can help reduce tissue inflammation and alleviate the discomfort associated with lichen plan.

[cta_produs style=”style_1″ product=”468759″ image=”https://aronia-charlottenburg.com/wp-content/uploads/2025/04/Ce-este-lichenul-plan-„lichenus-planus_-si-cum-se-manifesta_-Aronia-HERO-product.jpg”]

Diagnosis is primarily clinical, supported by the characteristic appearance of the lesions. In atypical cases or when ruling out other dermatological conditions (such as lichen sclerosus, lupus erythematosus, or precancerous lesions) is necessary, a skin biopsy is indicated. Histopathological examination reveals suggestive changes: hyperkeratosis, hypergranulosis, vacuolar degeneration of the basal layer, and a band-like lymphocytic infiltrate at the dermo-epidermal junction.

The therapeutic approach aims to alleviate symptoms and prevent recurrences, including topical or systemic corticosteroids, antihistamines, immunomodulators, and in some cases, phototherapy. Anti-inflammatory supplements can complement conventional treatment, helping to maintain a balanced immune response and support skin regeneration.

Types of Lichen Ruber Planus: Cutaneous, Oral, and Genital

Photo Source: Shutterstock.com

Lichen plan is a chronic inflammatory condition that can present in several clinical forms, depending on the affected anatomical area. In most cases, it begins on the skin, but it can also involve the mucous membranes, nails, scalp, or, less commonly, other epithelial surfaces.

Cutaneous Form

The **cutaneous form** is the most frequently encountered. It is characterized by polygonal, flat, violaceous papules with a shiny surface, usually appearing symmetrically on areas such as the wrists, forearms, or ankles. The lesions can persist for months or even years, sometimes leaving behind post-inflammatory hyperpigmentation. A characteristic phenomenon of this form is the Koebner phenomenon, where lesions develop in traumatized areas of the skin. Itching – sometimes intense – is a dominant symptom, affecting the quality of sleep and the patient’s general well-being.

Oral Lichen Planus

**Oral lichen planus** is another common variant, which can occur alone or in association with the cutaneous form. Lesions present as networks of whitish lines (Wickham’s striae), typically on the buccal mucosa, tongue, or gums. There are several clinical types: the reticular form, often asymptomatic; the erosive form, which causes painful ulcers; and the atrophic form, where the mucosa appears thin and reddish. Oral lichen planus is recurrent and may require long-term monitoring.

Genital Form

The **genital form** can affect both sexes. In men, it frequently localizes to the glans, foreskin, and scrotum, appearing as discrete papules or whitish plaques. In women, the vulva and vagina are involved, with possible reticular or erosive lesions. Symptoms may include itching, burning, and dyspareunia. In extensive forms, there is a risk of developing complications such as synechiae or vaginal stenosis.

Lichen Plan Pilaris & Actinic

In addition to these common presentations, there are also less common but clinically and therapeutically relevant forms. **Lichen plan pilaris** affects hair follicles, particularly on the scalp, leading to scarring alopecia over time. The nail form manifests as dystrophy, longitudinal striations, thinning of the nail plate, and in severe cases, nail loss. **Actinic lichen planus** appears on sun-exposed areas and is accompanied by hyperpigmented lesions, while the hypertrophic form produces thickened, warty plaques, especially on the legs, with marked itching.

More rarely, other regions may be affected, such as the esophageal mucosa, causing progressive dysphagia, or the ocular conjunctiva, where lesions can lead to severe complications if not treated properly.

Causes of Lichen Plan

As mentioned, the exact cause of lichen plan is not fully understood, but the involved mechanisms suggest an abnormal immune response directed against skin and mucosal cells. The condition is not contagious and is not transmitted through direct contact, but it can be influenced by certain triggers or predisposing factors.

Suspected causes include hepatitis C virus infection, which has been consistently associated with a higher incidence of the disease. Additionally, certain medications – particularly those used for blood pressure control, arthritis treatment, or cardiovascular diseases – can cause lichenoid eruptions resembling classic lichen planus. Among the implicated substances are beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), and antimalarials. Vaccines, heavy metals, and other chemicals can also trigger lesion development in rare cases.

Another factor involved in triggering or worsening symptoms is chronic psychological stress. Although not a direct causative factor, stress can influence immune system function and promote the onset or recurrence of inflammatory lesions.

Koebner Phenomenon – Lesions Induced by Local Trauma

In some cases, local trauma can lead to the appearance of lesions in areas previously affected by scratching, burns, or pressure – a phenomenon known as the Koebner phenomenon. This is commonly observed in patients with active disease forms and highlights the importance of protecting the skin from mechanical aggressions.

While anyone can develop lichen plan, the condition is more common in middle-aged adults, with a slight predominance in women. The course is variable – from localized, self-limiting forms to extensive or recurrent forms requiring long-term monitoring and treatment.

Essentially, understanding these potential risk factors allows for a more effective management approach to the disease, by identifying and avoiding aggravating factors and personalizing treatment based on each patient’s context. Furthermore, a good understanding of the causal factors contributes to the development of modern therapeutic strategies that aim not only to suppress symptoms but also to regulate the abnormal immune response underlying the disease.

Diagnosis of Lichen Plan

The diagnosis of lichen plan typically begins with a thorough clinical evaluation, based on discussion with the patient and examination of the lesions on the skin or mucous membranes. The doctor will assess the symptoms, their duration, and possible triggering factors, including medical history and recent treatments. Typical lesions – violaceous, flat, shiny papules – often appear in areas such as the wrists, forearms, or ankles. More so when the mucous membranes are affected, fine white lines (Wickham’s striae) may be observed, particularly in the oral cavity.

For the most accurate diagnosis, the doctor may use dermatoscopy, a non-invasive method that helps visualize the morphological details of the lesions more clearly. This technique can highlight subtle structures such as the whitish networks on the surface of the lesions or areas of active inflammation.

In cases where the diagnosis is not evident, or when atypical forms occur, a skin biopsy is indicated. This involves collecting a small piece of affected skin, which is then analyzed microscopically. On histopathological examination, lichen plan shows characteristic changes, such as thickening of the horny layer (hyperkeratosis), increased granulosum (hypergranulosis), and a dense, band-like lymphocytic infiltrate at the junction between the dermis and epidermis. These findings help differentiate lichen plan from other skin diseases with similar appearances.

Direct Immunofluorescence – Diagnosis in Bullous Conditions

In some situations, the doctor may also recommend direct immunofluorescence, an investigation that allows visualization of immune protein deposits in the skin. This is particularly useful in atypical forms or when differentiating from other bullous conditions is necessary.

Blood tests do not diagnose lichen plan but can be useful in identifying any associated conditions. For instance, testing for hepatitis C is important, as infection with this virus is frequently associated with the occurrence of lichenoid lesions, especially on mucous membranes.

Therefore, for a complete diagnosis, differential testing is essential. Some skin diseases, such as psoriasis, discoid lupus erythematosus, or adverse drug reactions, can resemble lichen plan. Hence, a detailed medical history related to recent treatments is crucial for ruling out possible drug-induced lichen planus.

By combining clinical examination, paraclinical investigations, and specific tests, the dermatologist can accurately establish the diagnosis and initiate appropriate treatment, thereby reducing the risk of complications and significantly improving patient comfort.

Recommended Drug Treatments for Lichen Plan

Lichen plan treatment varies depending on the type and severity of symptoms, as well as the affected area. In mild forms with minimal discomfort, active treatment may not be necessary. However, when itching is intense or lesions are widespread or painful, a tailored therapeutic approach is required.

Among the most commonly used treatment options are:

• Corticosteroids – These are frequently used to reduce inflammation and itching. They are applied as creams or ointments, but in more severe forms, they can also be administered orally or by injection. For skin lesions, high-potency creams are typically used, and for those in the oral cavity, special adhesive gels that adhere well to the mucosa are used.
• Calcineurin Inhibitors – Tacrolimus and pimecrolimus are an effective alternative to corticosteroids, especially for sensitive areas like the mouth or genital region, where the skin is thinner and more prone to irritation.
• Retinoids – These are vitamin A derivatives and can be administered topically or systemically. They are particularly recommended for chronic, hypertrophic, or erosive forms where other treatments have not yielded results.
• Immunosuppressive Drugs – For severe and widespread cases where other treatments are ineffective, the doctor may prescribe medications such as cyclosporine or methotrexate. These control the immune system’s reaction but require close monitoring and regular tests due to potential side effects.
• Antihistamines – These are useful for alleviating intense itching and improving nighttime comfort.
• Phototherapy – Controlled exposure to narrow-band UVB light can be effective for widespread cutaneous lichen plan. This is a procedure performed under medical supervision, over several sessions.

In addition to the physician-prescribed treatment, there are also **simple measures that can be applied at home** to reduce symptoms and prevent worsening:

• Cold compresses can soothe inflammation and burning sensations.
• **Over-the-counter anti-itch creams** can be applied to reduce itching.
• Avoiding scratching is important to prevent the Koebner phenomenon, i.e., the development of new lesions on traumatized areas.

If lichen plan affects the oral cavity, it is important to:

• Avoid acidic, spicy, or crunchy foods, which can irritate the lesions.
• Avoid alcohol-based mouthwashes, as they can intensify pain.
• Use local anesthetic solutions (such as those containing lidocaine) before meals.
• Consume soft, cool foods to minimize irritation.
• Visit the dentist regularly, especially if the lesions are persistent.

In essence, the effectiveness of drug treatment depends on daily care measures. Only then can the symptoms of lichen plan be better controlled, and patients’ quality of life can significantly improve.

Lichen Plan: Approaches, Natural and Complementary Treatments (Teas, Creams, and Other Options)

Photo Source: Shutterstock.com

In addition to treatments recommended by a doctor, some individuals with lichen plan choose to incorporate natural remedies or complementary therapies into their routine to reduce discomfort and support the healing process. While these methods do not replace medical treatment, they can offer additional benefits, especially when applied correctly and under specialist supervision.

Here are some examples of useful natural treatments and complementary measures:

1. Herbal Medicine and Medicinal Teas
   Certain medicinal plants may have calming and anti-inflammatory effects. For example:

• Chamomile tea can be used for mouth rinses in cases of oral lichen planus, providing anti-irritant and healing properties.
• Aloe vera gel, applied directly to the skin, has a moisturizing effect and can reduce inflammation and itching.
2. Supplements with Anti-inflammatory and Immunomodulatory Effects
• Omega-3, from fatty fish or capsules, helps reduce overall inflammation in the body.
• Vitamin D supports immunity, and in case of deficiency, supplementation may positively affect the disease’s course.
• Curcumin, the active substance in turmeric, is known for its anti-inflammatory properties and can be particularly useful in chronic forms.
3. Topical Remedies for Symptom Relief
• Coconut oil is used to moisturize the skin and relieve itching, also possessing antimicrobial effects.
• Propolis, applied topically, can aid in wound healing in the oral cavity due to its antimicrobial and regenerative properties.
4. Stress Reduction Techniques
   Stress can worsen symptoms in lichen plan, so it is important to adopt relaxation methods such as:
• Gentle physical exercises;
• Relaxing activities that reduce emotional tension.

Caution!
>>>>>>>>>Even though natural methods can be beneficial, it is essential to consult with your doctor before incorporating them into your daily routine, especially if you are undergoing medical treatment. Some supplements or herbs may interact with medications or worsen symptoms.

Diet and Lifestyle for Patients Diagnosed with Lichen Plan + What are the Specific Contraindications?

Diet and lifestyle can influence the course of lichen plan, particularly regarding symptom intensity and the risk of recurrence.

Firstly, a balanced diet based on anti-inflammatory principles can be beneficial in managing chronic inflammation. It is advisable to consume fresh vegetables, leafy greens, berries, carrots, and other natural sources of antioxidants daily. These support immunity and help protect tissues from oxidative damage.

Simultaneously, it is recommended to include foods rich in omega-3 fatty acids in your diet, such as salmon, sardines, or mackerel. If fatty fish is not part of your regular diet, discuss with your doctor about incorporating fish oil supplements.

Hydration – Importance for Managing Lichen Plan

Hydration is essential in all types of lichen plan, as affected skin and mucous membranes require optimal moisture levels for repair. Adequate water intake throughout the day is recommended, and in oral forms of the disease, it is advisable to avoid very hot or very cold liquids, which can exacerbate local irritation.

In parallel, it is useful to identify foods that can trigger or worsen discomfort. For some individuals, acidic (citrus fruits, vinegar), spicy, or extreme temperature foods can increase local sensitivity, especially in cases of oral mucosal involvement.

Stress management is another important component, as many patients observe that symptoms intensify during stressful periods. Relaxing activities like gentle walks can be incorporated into the daily routine. Additionally, regular physical exercise performed at a moderate pace can contribute to both relaxation and immune system balance.

For cutaneous forms, skin care should be adapted to avoid any potential irritants. It is recommended to use hygiene products without fragrances, alcohol, or other harsh agents. The skin should be kept well-hydrated by daily application of emollients or soothing lotions, especially after bathing or showering. In case of sun exposure, using high-SPF sunscreens is important, especially if there are visible lesions or if the patient has an actinic form of the disease.

Thus, by adopting a balanced lifestyle that is attentive to the body’s needs, patients with lichen plan can actively contribute to symptom control and support the effects of ongoing medical treatment.

Long-Term Evolution of Lichen Plan

Lichen plan is an inflammatory condition with a variable course that can span long periods. The disease often progresses in episodes – periods of activity alternate with remission intervals, sometimes spontaneous, other times achieved through treatment. The way it manifests and the duration of these episodes differ from person to person, depending on the clinical form, affected area, and individual response to treatment.

Generally, the cutaneous form of the disease tends to improve over time, and in many cases, the lesions disappear on their own within a year or two. Even so, temporary pigmentary marks may remain on the skin after the rash heals.

Oral lichen planus, however, has a slower course and tends to be recurrent. Lesions in the oral mucosa can persist for years, requiring constant care and regular monitoring. Although the risk of malignant transformation is low, it exists, which is why periodic check-ups are recommended.

Genital Lichen Plan – Complications and Treatment

The genital form can be more challenging to treat. The genital form tends to become chronic. In some women, persistent lesions can lead to structural complications over time. Examples of structural complications include mucosal fusions. Examples of structural complications include mucosal constrictions. These complications affect comfort. These complications affect quality of life.

The course of the disease can be influenced by several factors. One factor is the effectiveness of the applied treatment. One factor is the avoidance of triggering factors (such as stress). One factor is the avoidance of triggering factors (such as certain medications). One factor is the presence of other underlying conditions (such as liver diseases). One factor is the presence of other underlying conditions (such as autoimmune disorders). In many situations, complete remission is possible. This is especially true if the condition is diagnosed early. This is especially true if the condition is treated correctly.

In the long term, regular medical supervision is important. This is especially true for forms involving mucous membranes. This is especially true for forms presenting with extensive lesions. An essential part of management involves continuously adapting the treatment to the patient’s needs. Adaptation is based on the response to therapies. Adaptation is based on symptom progression.

Despite this data, current research offers promising prospects for patients with lichen plan. New treatments are being developed. These treatments are more precisely targeted at the immune mechanisms underlying the condition. This could increase treatment efficacy. It could reduce the risk of future recurrences.

In conclusion, lichen plan requires careful management. Lichen plan requires long-term management. By adhering to the recommended treatment, most patients can maintain effective symptom control. Through regular monitoring, most patients can maintain effective symptom control. By adopting a balanced lifestyle, most patients can maintain effective symptom control. Most patients can maintain a good quality of life. Furthermore, constant communication with the specialist remains essential for the correct adaptation of the therapeutic approach.

 

References:

1. Cheng, S., Kirtschig, G., Cooper, S., Thornhill, M., Leonardi-Bee, J., & Murphy, R. (2012). Interventions for erosive lichen planus affecting mucosal sites. Cochrane Database of Systematic Reviews, 2012(2), CD008092. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008092.pub2/full;
2. Gorouhi, F., Davari, P., & Fazel, N. (2014). Cutaneous and mucosal lichen planus: a comprehensive review of clinical subtypes, risk factors, diagnosis, and prognosis. The Scientific World Journal, 2014, 742826. https://www.hindawi.com/journals/tswj/2014/742826/;
3. Le Cleach, L., & Chosidow, O. (2012). Clinical practice. Lichen planus. The New England Journal of Medicine, 366(8), 723-732. https://www.nejm.org/doi/full/10.1056/nejmcp1103641;
4. Usatine, R. P., & Tinitigan, M. (2011). Diagnosis and treatment of lichen planus. American Family Physician, 84(1), 53-60. https://www.aafp.org/pubs/afp/issues/2011/0701/p53.html;
5. van der Meij, E. H., Mast, H., & van der Waal, I. (2007). The possible premalignant character of oral lichen planus and oral lichenoid lesions: a prospective five-year follow-up study of 192 patients. Oral Oncology, 43(8), 742-748.

Photo Source: Shutterstock.com