What is lichen planus?
Lichen planus is a skin disease, which is characterized by a benign keratoses often on the buccal mucosa, but also at other places in the mouth, such as on the tongue. Also on the skin and on the genital mucosa can prevent lichen planus. On the skin, the disorder is characterized by the emergence of small, itchy papules flat, with a color ranging from red to pale purple. Predilection sites of these skin disorders are the bending side of wrists and forearms, neck, the area around the sacrum and genitals and ankles.
There are different forms of lichen planus.
- The reticular form: is the most common form, clinical clearly recognizable by its white lines that criss-cross, called striae of Wickham.
- The erosive / atrophic form: is the second most common form, manifests itself as a superficial erosion of the mucosa (thus no ulceration or ulcer), which gives a burning sensation.
- The bullous form: is a rather rare form in which blisters appear that may burst and give ulcerations. This form is extremely painful and gives a burning sensation.
- Lichen planopilaris with particular hair follicles are affected. This can lead to scarring and partial hair loss.
Lichen Planus Causes
The etiology (cause) of lichen planus is to date unknown. It is not contagious and there is no link with any known pathogen.
Lichen-planusachtige rash (known as lichenoïde comments) occurs sometimes due to allergic reactions to medications for high blood pressure, heart disease and arthritis. These are called medicijngeïnduceerde lichenoïde reactions. These lichenoïde reactions can lichenoïde mucositis (of mucous membranes) or lichenoïde dermatitis (of the skin) are. Lichen planus has been reported as in-effect of chronic hepatitis C infection or may be a sign of a graft-versus-host reaction (an immune response) in the skin. Real lichen planus has been associated with stress where injury shows itself on the mucous membranes or on the skin during times of stress in people with this condition. Lichen planus is more common in women than in men (with a ratio of 3: 2) and is most common in people of middle age. Lichen planus in children is rare.
In three young women is lichen planus associated with hyperthyroidism
Reactions to amalgam fillings may contribute to oral lesion that resembles lichen planus, and research has shown that many of these injuries will disappear if another material used for fillings.
Histopathology
Histopathological examination with the microscope is classic case of:
- A thickened stratum corneum (hyperkeratosis without parakeratosis).
- The granular layer is irregularly thickened.
- There is acanthosis: a diffuse thickening of the stratum spinosum.
- There is an infiltrate of lymphocytes that attack the kertatinocyten of the basal layer. This infiltrate is band-shaped.
- There is necrosis of basal keratinocytes, with the formation of uniformly pink-colored cell debris, and the so-called civatte-- colloidlichamen.
Because nature is variable, and there are about 20 types of lichen planus exist, do not have all the qualities to be equally pronounced. Lichen planus is often associated with lichen sclerosus for.
Oral Lichen Planus Treatment
The treatment of oral lichen planus (OLP) is within the range of the oral medicine. At present there is no cure for oral lichen planus but there are medications used to reduce the effects of the inflammatory response. Oral lichen planus may go dormant after treatment and there are reports that oral lichen planus can suddenly flare up years after it was thought to heal it.
Medications that are used to treat lichen planus include:
- Oral and topical steroids
- Oral retinoids
- Immunosuppressants, including:
-Hydroxychloroquine
-Tacrolimus
-Dapsone
Non-drug treatments:
- Narrow band UVB phototherapy
- Aloe Vera
- Purslane