Lichen Planus is a common, inflammatory, often irritating skin rash. It primarily affects the skin, scalp, mucous membranes, nails and genitals. Lichenoid keratoses usually appears as itchy, purplish-colored, flat-topped bumps or lesions on the skin. It can also cause soreness and inflammation in the mouth, tongue, lips and vagina.
Causes Of Lichenoid Keratoses
The exact cause of Lichenoid keratoses is unknown. However, it is believed to be an immune-mediated reaction that results due to an interaction between T lymphocytes (a type of white blood cells) and the basal cells of the epidermis (outermost layer of the skin). Some possible triggering factors include:
- Medications: Certain drugs like anti-malarial medications, anti-tubercular drugs, tranquilizers and non-steroidal anti-inflammatory drugs (NSAIDs) have been linked to Lichenoid keratoses.
- Hepatitis C infection: 10–20% of Lichenoid keratoses cases are associated with hepatitis C infection.
- Metals/dental work: Exposure to mercury, gold and other metals through dental fillings, implants or jewelry is considered a potential cause.
- Stress: Psychological stress is thought to play a role in exacerbating Lichenoid keratoses symptoms in some individuals.
- Genetics: There appears to be a genetic predisposition as Lichenoid keratoses may run in families.
Clinical Features And Diagnosis
Some characteristic features of Lichen Planus based on its location are:
Skin: Asymmetrical purplish polygonal flat-topped papules and plaques with lacy whitish lines. Common sites are wrists, shins and lower back.
Mouth: Whitish lesions that may erode or bleed. The buccal mucosa (inner cheeks), tongue and gums are commonly affected.
Genital Area: May present as itchy purple flat-topped papules in women commonly affecting the vulva. In men, tiny lesions under the foreskin.
Nails: Vertical ridging or lines on fingernails.
Diagnosis is usually based on the appearance of the rash and confirmed through skin biopsy. Other conditions like lichenoid drug eruptions are considered in the differential diagnosis.
Treatment And Management Of Lichen Planus
Mild localized Lichenoid keratoses may not need treatment and resolves on its own within months. However, therapy is considered for relieving symptoms or preventing complications in severe, persistent or widespread cases. Some treatment options include:
- Topical corticosteroids: Potent topical corticosteroid creams or ointments are first-line treatment for localized skin and genital lesions.
- Oral corticosteroids: Oral corticosteroids like prednisone are used for severe, widespread skin involvement. However, side effects are a concern with long term use.
- Topical retinoids: Vitamin A derivatives like tretinoin are applied to the skin to control Lichenoid keratoses lesions.
- Immunosuppressants: Drugs like azathioprine, cyclosporine and methotrexate that suppress the immune system are used for recalcitrant Lichenoid keratoses resistant to other therapies.
- Antiviral therapy: Medications targeting the hepatitis C virus are considered if Lichenoid keratoses is associated with HCV infection.
- Dental management: Topical corticosteroids and mouthwashes help treat oral Lichenoid keratoses lesions. Removable plastic appliances can protect the mouth.
- Laser therapy: Carbon dioxide (CO2) laser removal may be helpful for genital and oral Lichenoid keratoses lesions that do not respond to medication.
- Acitretin: A retinoid drug taken orally, is used for severe or extensive Lichenoid keratoses as a last resort.
Prognosis Of Lichen Planus
The prognosis of Lichenoid keratoses depends on the severity and location of involvement. While skin lesions typically heal within months to a few years without scarring, oral Lichenoid keratoses carries risks of malignant transformation in 1-2% of longstanding untreated cases (over 20 years). Genital lesions usually resolve more slowly over 1-2 years. With proper treatment, the prognosis is excellent in most cases of Lichenoid keratoses. Recurrences are common in some individuals upon tapering therapy. Long term follow up is recommended for persistent oral Lichenoid keratoses to screen for cancer development.
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*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it