Red lichen, also known as lichen planus, is an inflammatory condition affecting the skin, hair, nails, and mucous membranes. It is not contagious and is considered an autoimmune-like disorder, where the body’s immune system mistakenly targets its own cells.
Identifying Red Lichen
Red lichen on the skin appears as purplish, polygonal, flat-topped bumps or plaques that are shiny and intensely itchy. These lesions often measure 3-5mm and may be covered with fine white lines, known as Wickham’s striae. The rash frequently appears on the wrists, ankles, lower back, and shins, often in a symmetrical pattern.
When red lichen affects the oral cavity, it appears as lacy white patches on the inside of the cheeks, tongue, or gums. While these patches may not cause discomfort, severe cases can lead to redness, burning sensations, or painful erosions and sores. Oral lichen planus affects about half of all individuals with the condition.
On the scalp, red lichen (lichen planopilaris) can cause redness, irritation, and small bumps around hair follicles. This can lead to thinning hair and, in some instances, permanent hair loss. The nails can also show signs of red lichen, with changes such as thinning, ridging, splitting, or even complete nail loss.
Red lichen can also affect the genital area, appearing as purplish or white ring-shaped patches or flat-topped, shiny bumps on the penis or vulva. These lesions can be painful and cause discomfort, particularly on the vulva.
Understanding Its Causes
Red lichen is an inflammatory response where the immune system mistakenly attacks healthy cells. While the exact cause remains unknown, it is believed to involve an abnormal immune system reaction, causing the body’s defense system to become overactive and target its own tissues.
Several factors may trigger or worsen red lichen. Certain medications have been linked to its development, including some for high blood pressure, nonsteroidal anti-inflammatory drugs (NSAIDs), and antimalarial drugs. Viral infections, such as Hepatitis C, are also associated with an increased risk.
Stress may trigger flare-ups of red lichen. For oral red lichen, reactions to dental materials, such as metal fillings, have been implicated. While there can be a genetic predisposition, red lichen is not strongly hereditary.
Treatment Options
Managing red lichen focuses on reducing symptoms like itching, inflammation, and pain, as there is no cure. Mild cases affecting the skin may resolve on their own without specific treatment. However, when symptoms are bothersome, various medical approaches can provide relief and potentially speed healing.
Topical treatments are a common first line of defense for skin involvement. Corticosteroid creams and ointments are prescribed to lessen pain, swelling, and inflammation. Calcineurin inhibitors like tacrolimus ointment or pimecrolimus cream can help reduce bumps and discomfort, particularly for genital and oral red lichen.
For more widespread or severe cases, oral medications are necessary. Oral corticosteroids, such as prednisone, are prescribed for a short course to reduce inflammation and calm the immune system. Antihistamines alleviate intense itching. Other systemic treatments include retinoids, vitamin A derivatives that help clear widespread rashes, and immunosuppressants like methotrexate or cyclosporine, used when other treatments are ineffective.
Light therapy, phototherapy (UVB light), may help clear skin lesions. This treatment usually involves exposing the affected skin to UV light two to three times per week over several weeks. For oral red lichen, good oral hygiene is important, and lidocaine mouthwashes can help numb painful areas to facilitate eating. Avoiding known triggers, such as certain medications or irritants, can help manage the condition.
Outlook and When to Consult a Doctor
The course of red lichen can vary, with skin lesions often resolving spontaneously within one to two years. However, recurrences are common, and the affected skin may retain darker spots, known as post-inflammatory hyperpigmentation, even after the rash clears. Oral red lichen tends to be more chronic and may persist for a longer duration, sometimes up to five years, with symptoms tending to come and go. Hair loss from scalp involvement can be permanent.
While not generally considered dangerous, rare complications can arise with long-standing erosive red lichen, particularly in the mouth or genital areas. There is a small risk of developing squamous cell carcinoma in these locations. Regular check-ups with a healthcare professional are advisable to monitor for any changes in existing lesions, especially in these areas.
Consult a doctor, such as a dermatologist or dentist, if you suspect you have red lichen. A medical professional can confirm the diagnosis, often through a physical examination and sometimes a biopsy of affected tissue. Medical attention is recommended for persistent or worsening symptoms, severe itching, pain, or any signs of hair loss. Individuals experiencing difficulty eating or speaking due to oral lesions should consult a doctor or dentist promptly.