Lichen planus is a chronic, immune-related inflammatory condition that affects the skin and sometimes the mouth, genital area, scalp, and nails.

On the skin, it typically causes small, itchy, flat-topped, purplish-red bumps. In the mouth, it may cause white, lace-like lines or painful sores.

Lichen planus is not contagious. Appropriate treatment can help control itching, pain, and inflammation.

What Causes Lichen Planus?

The exact cause is not fully understood.

An inflammatory immune response directed against skin and mucosal cells plays an important role.

Genetic predisposition, certain medications, and environmental factors may be associated with the condition.

Some patients also have hepatitis C infection. Additional assessment may be considered based on medical history and individual risk.

Medication-induced lichenoid reactions can also resemble lichen planus.

What Are the Symptoms of Lichen Planus?

Symptoms vary depending on the area affected.

• Shiny, flat-topped, purplish bumps on the skin
• An itchy rash, particularly on the wrists and ankles
• White, lacy lines inside the mouth
• Oral burning, tenderness, or painful sores
• Genital redness, burning, and erosions
• Nail thinning, ridging, or changes in shape
• Scalp redness and, in some patients, permanent hair loss

Brown or gray marks may remain after skin lesions resolve.

Main Types of Lichen Planus

Cutaneous Lichen Planus

Itchy, purplish bumps commonly develop on the wrists, ankles, lower back, and legs.

Fine white lines called Wickham striae may appear on the surface of some lesions.

Oral Lichen Planus

White, lace-like lines may develop inside the cheeks, on the tongue, or on the gums.

Some patients develop painful sores and a burning sensation.

Regular assessment is particularly important for persistent oral sores that do not heal.

Genital Lichen Planus

This can affect the genital mucosa in women and men.

It may cause burning, pain, redness, and superficial sores. Scarring can develop in some severe, long-standing cases.

Lichen Planopilaris

Lichen planopilaris is an inflammatory form of lichen planus that affects hair follicles.

Scalp redness, scaling, and burning may occur. Without treatment, it can lead to permanent follicle loss.

Nail Lichen Planus

This can cause nail thinning, longitudinal ridging, splitting, or nail loss.

Early evaluation is important because some patients may develop permanent nail damage.

How Is Lichen Planus Diagnosed?

Diagnosis is usually based on a dermatologic examination.

The assessment considers the appearance and distribution of skin lesions, along with any oral or nail involvement.

Dermoscopy and a skin biopsy may be used when needed.

Biopsy and pathologic examination may be particularly important for persistent or suspicious oral lesions.

Current Treatments for Lichen Planus

Treatment is planned according to the areas affected, disease severity, and the patient’s symptoms.

1. Topical Corticosteroids

Corticosteroid creams or ointments are often among the first treatment options for localized cutaneous lichen planus.

They help reduce inflammation and itching.

A dermatologist determines the appropriate strength and duration of treatment.

2. Nonsteroidal Topical Treatments

Calcineurin inhibitors such as tacrolimus and pimecrolimus may be used in suitable patients, particularly on certain sensitive skin and mucosal areas.

Their use for lichen planus may be off-label in some circumstances.

3. Intralesional Corticosteroids

Corticosteroid injections into affected areas may be considered for thickened, localized, or resistant lesions.

They may also be used for selected cases involving the nails or scalp.

4. Phototherapy

Narrowband UVB phototherapy may help some patients with widespread cutaneous lichen planus.

However, it is not suitable for every type. Forms triggered by sunlight require a different approach.

5. Systemic Treatments

Oral medications may be needed for severe or widespread disease.

Options for selected patients may include corticosteroids, acitretin, methotrexate, hydroxychloroquine, or other medications that regulate the immune system.

These treatments require regular clinical follow-up and laboratory monitoring when appropriate.

6. Newer Targeted Treatments

New treatments targeting immune mechanisms involved in lichen planus are being investigated.

Promising results have been reported with JAK inhibitors and certain biologic medications.

However, these are not yet established routine treatments for all forms of lichen planus.

Their suitability should be assessed according to the type and severity of the condition and the available scientific evidence.

What Should People With Oral Lichen Planus Keep in Mind?

Oral lichen planus can persist and recur.

Appropriate local treatment and regular follow-up are particularly important for painful, erosive lesions.

• Avoid smoking and tobacco products.
• Limit alcohol consumption.
• Maintain good oral hygiene.
• Reduce spicy, acidic, or very hot foods if they worsen symptoms.
• Have nonhealing sores and changing lesions assessed promptly.

The risk of oral cancer in people with oral lichen planus is low but higher than usual. Regular monitoring is therefore necessary, particularly for persistent and erosive lesions.

This does not mean that every oral lichen planus lesion will become cancerous.

Can Lichen Planus Go Away Completely?

Cutaneous lichen planus may improve substantially over several months or a few years in some patients.

However, involvement of the mouth, genital area, scalp, or nails can be more persistent and resistant to treatment.

The condition may recur.

Treatment aims to control symptoms, reduce inflammation, and prevent permanent tissue damage.

Daily Care Tips for Lichen Planus

• Avoid scratching or irritating the skin.
• Use gentle, fragrance-free cleansers and moisturizers.
• Do not use potent corticosteroid creams without medical advice.
• Continue regular dental and dermatology checkups for oral lesions.
• Seek prompt evaluation for nail changes or patches of scalp hair loss.
• Tell your physician about any medications you have recently started.
• Do not stop medications on your own.

When Should You See a Dermatologist?

A dermatologic evaluation is recommended for persistent, itchy, purplish rashes, white lines inside the mouth, or sores that do not heal.

Early evaluation is particularly important for permanent scalp hair loss, progressive nail changes, or painful genital sores.

Dermatologic Evaluation and Follow-Up

At Dr. Armin Müştak’s private dermatology practice, patients with suspected lichen planus receive a dermatologic examination.

An appropriate treatment and follow-up plan is developed based on the areas affected, disease severity, and any mucosal or nail involvement.

Accurate diagnosis, appropriate treatment, and regular follow-up are important for controlling lichen planus and helping prevent permanent tissue damage.