Lichen planus is a rash that affects the skin and, less frequently, the mucosae, hair, and nails. It is distinguished by intensely itchy polygonal papules with a violaceous hue.
There are no gender or racial predispositions, and it affects people of all ages, with people between the ages of 30 and 60 being the most frequently affected.
Etiology
Although the exact cause is unknown, an immune pathogenesis is thought to be responsible because of the association with thymoma, graft-versus-host disease, and some autoimmune diseases like myasthenia gravis.
Hepatitis B, C, and chronic active hepatitis can all cause rashes that exhibit the clinical and histological characteristics of lichen planus.
Patients who take medications—most frequently thiazide diuretics, penicillamine, sulphonamides, antimalarials, gold and other heavy metals—also experience rashes.
They can also happen to people who work with color developers.
Pathogenesis
The picture suggests an immune response to an unidentified epidermal antigen because there is hyperkeratosis, a prominent granular layer, basal cell degeneration, a heavy T lymphocyte infiltration, and a “sawtooth” dermo-epidermal junction caused by the interaction between T cells and basal cells.
Clinical features
Distribution site:
Wrists, specifically its volar/flexor portion
· Ankles
· Oral mucous membrane
· Shins
· Lower back and genitalia
Signs and symptoms include:
Shiny, violaceous plaques and papules with flat tops
At the sites of skin friction, there are purple papules and purple nodules.
Asymptomatic or aching but not painful
· Polygonal
Severe pruritus; excoriations are rare because the patients tend to rub rather than scratch.
Wickham striae, which are tiny lacy white spots on top of papules, are most noticeable in the oral mucosa.
(Koebner phenomenon) New lesions are brought on by scratching and trauma.
Cicatricial alopecia may result on the scalp as a result.
Nail lichen planus
10% of patients have involvement with their nails.
Longitudinal nail plate ridging, with thinning nail plates
Matrix scarring that results in anonychia and pterygium, a condition where the nails grow in like wings permanently.
Rarely, papules will split a nail and produce the “tented nail” or “pup tent sign.”
Oral mucosa lichen planus
Lips, the tongue, the gingiva, and the buccal mucosa are common sites.
White striae in the mouth can range in severity from a minor eruptive mucosal eruption that is white and reticulate to a serious erosive stomatitis.
Ulcers to severe gingivitis and stomatitis that are erosive.
The buccal mucosa frequently has white streaks that resemble lacework and are very distinctive.
Years of erosive stomatitis can be expected, and the condition may raise the risk of developing oral squamous cell carcinoma.
Lichen planus lesions from the oral mucosa can occasionally spread to the larynx and esophagus, causing dysphagia and the development of benign strictures.
Lichen planus in young men is only found on the mouth and/or genitalia.
erosive gingivitis with desquamative lichen planus in females.
Homeopathy medicines
There are many effective medicines available in homoeopathy for treating lichen planus, but the choice depends on the individuality of the patient, taking into account the mental and physical symtoms of the condition. Homoeopathy is a growing system that is practiced throughout the world today.
Agaricus muscarius
Papular, pustular, and edematous lesions, as well as small pimple-like eruptions with red areolas and excruciating itching and burning, are all common symptoms.
Anthrakokali
Itchy skin lesions with papules on the hands and feet.
Antimonium crudum
Tongue coated thickly white, as if whitewashed. The edges may be red and sore. Sensitive to cold bathing. Nails discolored and deformed. Scaly, pustular eruption with burning and itching, worse at night. Rough scaling skin with horny patches. Great tenderness in horny patches. Thick, hard, honey-colored scabs. Itching when warm in bed. Dry skin. Itching of scalp and falling out of hair.
Arsenicum album
Malignant pustules, ulcers with raised and hard edges, surrounded by a red and shining crown, with the bottoms like hard, or of a blackish-blue, with burning pains or shooting, typically when the parts affected become cold. Great agony and restlessness. Changes places frequently. Fear of death. Itching, burning, swelling; edema; eruption popular, dry, rough, scaly; worse cold and scratching.
Arsenicum iodatum
Large scales of skin are markedly exfoliated, leaving a raw, oozing surface underneath. These lesions are dry, scaly, and itchy.
Borax
For oral lichen planus, look for the following symptoms: tongue and cheek ulcers, hot, sore mouth, bitter aftertaste, dry, cracked, or puffy tongue, and ulcers that bleed when touched or when eaten.
Dulcamara
Vesicular eruptions, humid eruptions, itchy, thick, brownish-yellowish crusts that bleed when scratched, large, smooth warts on the face and palmar surfaces of the hands, pruritus that is always worse in cold, wet weather.
Juglans cineraria Q
Pustules on the thighs, hips, and nates with itching and burning; a few pustules on the body, face, and arms; an eczema-like eruption on the upper chest with itching that pricks when heated by overexertion; intermittent itching on the head, neck, and shoulders with pricking, burning, and redness; and itching on the arms that gets better from scratching.
Kali arsenicosum
Itchy skin that is dry, scaly, and wilted, with a great deal of small nodules under the skin, and intolerable itching that is worse when you take off your clothes.
Kali bichromicum
Papular eruption with burning pains, deep, stinging cicatrice that covers the hands, an ulcer with punched-out edges that has a propensity to penetrate, and persistent exudate.
Ledum palustre
Small red millet-seed-sized pimples that have appeared all over the body have caused severe scratching, edematous swelling, and intense itching on the covered parts of the feet and ankles.
Mercurius sol
For oral lichen planus. Irregular ulcers inside the cheeks with poorly defined edges, an unhealthy appearance, a metallic taste in the mouth, excessive salivation, and an increase in thirst for water.
Plantago major
Swelling of the cheeks, excessive salivation, a taste that is dirty, putrid, and clammy, and bad breath are all symptoms of oral lichen planus.
Sulphur
Skin affections after local medications. Very red lips and face. Pruritus, especially from warmth, in the evening, frequently recurs in springtime, in damp weather. Aversion to being washed, always worse after bath. Craving for sweets. Dry, scaly, unhealthy skin; every little injury suppurates. Itching, burning; worsened by scratching and washing. Dirty, filthy people, prone to skin affections.
Sulphur iodatum
Lichen planus, papular eruption on the face, arms covered in an itchy rash, and hair that feels erect. Obstinate skin affections include painless gland enlargement, infiltration of tissues, and thickening and induration after inflammation.
Thuja occidentalis
Brown spots on the hands and arms, dry skin with brown spots, extremely sensitive skin to touch, sweet-smelling, heavy perspiration, and pigmented lichen planus are all symptoms.
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