Lichen Planus

Lichen Planus

1. Definition: Lichen planus is a chronic inflammatory disease that affects the mucous membranes and skin. It is an autoimmune disease where the immune system attacks the skin and mucous membranes, causing inflammation and damage.

2. Causes / Etiology: The exact cause of lichen planus is not known, but it is thought to be an autoimmune disease triggered by a combination of genetic and environmental factors. Some possible triggers include:

• Viral infections
• Stress
• Hormonal changes
• Medications (such as beta blockers and antimalarials)

3. Types or Classification

• Oral Lichen Planus: This type affects the mucous membranes inside the mouth and can cause ulcers, redness, and white patches.
• Cutaneous Lichen Planus: This type affects the skin and can cause purplish, itchy, flat patches or bumps.
• Vulvar Lichen Planus: This type affects the vulva and can cause itching, burning, and redness.
• Genital Lichen Planus: This type affects the genitals and can cause itching, burning, and redness.
• Nail Lichen Planus: This type affects the nails and can cause thinning, ridging, and brittleness.
• Hair Lichen Planus: This type affects the hair and can cause hair loss and thinning.

4. Pathology The pathology of lichen planus involves the following steps:

• Step 1 → T cell activation: The immune system is activated, and T cells are stimulated to attack the skin and mucous membranes.
• Step 2 → Inflammation: The immune system releases chemicals that cause inflammation and damage to the skin and mucous membranes.
• Step 3 → Basement membrane destruction: The immune system breaks down the basement membrane, which is the layer of tissue that supports the skin and mucous membranes.
• Step 4 → Collagen degeneration: The immune system breaks down the collagen, which is the protein that gives skin and mucous membranes their strength and structure.
• Step 5 → Skin and mucous membrane damage: The skin and mucous membranes become damaged and inflamed, leading to the symptoms of lichen planus.

5. Clinical Features General features of lichen planus include:

• Itching (pruritus)
• Redness
• Blisters
• Ulcers
• White patches

Specific features of lichen planus include:

• Oral lichen planus: ulcers, redness, and white patches inside the mouth
• Cutaneous lichen planus: purplish, itchy, flat patches or bumps on the skin
• Vulvar lichen planus: itching, burning, and redness on the vulva
• Genital lichen planus: itching, burning, and redness on the genitals
• Nail lichen planus: thinning, ridging, and brittleness of the nails
• Hair lichen planus: hair loss and thinning

6. Complications

• Acute complications:

• Infection

• Scarring

• Nerve damage

• Eye damage

• Chronic complications:

• Skin and mucous membrane damage

• Hair loss and thinning

• Nail thinning and brittleness

• Eye damage

7. Diagnosis / Investigations

• Routine tests:

• Physical examination

• Medical history

• Laboratory tests (e.g. blood tests, urine tests)

• Special tests:

• Biopsy (to examine tissue under a microscope)

• Histopathology (to examine tissue under a microscope)

• Immunohistochemistry (to examine tissue under a microscope)

8. Management

• General management:

• Avoiding triggers (e.g. viral infections, stress)

• Using moisturizers and topical creams

• Avoiding scratching

• Modern treatment:

• Corticosteroids (to reduce inflammation)

• Immunomodulators (to suppress the immune system)

• Biologics (to target specific proteins involved in the immune response)

• Dietary advice:

• Eating a balanced diet

• Avoiding spicy or acidic foods

• Staying hydrated

9. Homeopathic Therapeutics

• 1. Arsenic Album:

• Itching and burning sensations

• Redness and inflammation

• Ulcers and blisters

• Hair loss and thinning

• Nail thinning and brittleness

• Eye damage

• 2. Graphites:

• Itching and burning sensations

• Redness and inflammation

• Ulcers and blisters

• Hair loss and thinning

• Nail thinning and brittleness

• Skin and mucous membrane damage

• 3. Mezereum:

• Itching and burning sensations

• Redness and inflammation

• Ulcers and blisters

• Hair loss and thinning

• Nail thinning and brittleness

• Eye damage

• 4. Rhus Tox:

• Itching and burning sensations

• Redness and inflammation

• Ulcers and blisters

• Hair loss and thinning

• Nail thinning and brittleness

• Skin and mucous membrane damage

• 5. Silicea:

• Itching and burning sensations

• Redness and inflammation

• Ulcers and blisters

• Hair loss and thinning

• Nail thinning and brittleness

• Eye damage