Introduction
Lichen planus is an inflammatory skin condition, characterized by an itchy, non-infectious rash on the arms and legs. It consists of small, many-sided, flat-topped, pink or purple bumps. Considered to be an autoimmune disease, it typically occurs in people over the age of 30 years. It occurs more in females than in males. People with liver diseases, such as hepatitis C or cirrhosis are more susceptible to lichen planus. Mouth is a common site of inflammation and clinical manifestation of lichen planus and the condition is known as oral lichen planus. Top of Form
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Signs & symptoms
Itchy, discoloured patch or patterns of shiny, raised, red, pink, or purple, flat-topped bumps on skin inside cheeks & tongue.
Papules, approximately 3 to 5 mm in diameter.
White streaks may sometimes appear on the papules, called Wickham’s striae. Intense itching may occur, especially at night.
The first attack can continue for weeks, and even months, while recurrences can go on for years. Recurrence is common in cases of oral lichen planus.
Oral lichen planus
- White streaks appear on the inside of the cheeks. The gums, tongue, and lips may also be affected.
- The streaks are not usually painful or itchy but they do not resolve.
- Redness and blistering of the gums.
- Sore mouth ulcers can develop and recur.
- Loss of taste, metallic taste in mouth.
- Dryness of mouth.
Causes
The exact cause of lichen planus is still not known.
It is considered to be autoimmune disorder, where the immune system mistakenly attacks healthy tissues.
Hereditary factors do not play any role in this condition.
It is not an infectious condition
It is not related with malnourishment/deficiencies. However, spicy foods, citrus juices, and tomato products may aggravate symptoms if there are open sores in the mouth.
Some causes of lichen planus are thought to involve the following:
Medications – Lichen planus can occur as a reaction to certain medicines, including:
- Beta-blockers, which are common drugs used to treat cardiovascular problems
- anti-inflammatory medications
- antimalarials
- thiazide diuretics
- phenothiazines, a group of tranquilizing drugs with antipsychotic actions
Mercury tooth fillings: Some studies have found a link between lichen-planus-type changes in the mouth and an allergic reaction to mercury tooth fillings.
Lichen planus can also be part of Grinspan’s syndrome, a syndrome characterized by hypertension, diabetes, and oral lichen planus.
Pathophysiology
The classic histopathologic features of Oral Lichen Planus include liquefactive degeneration of the basal cell accompanied by apoptosis of the keratinocytes, a dense band-like lymphocytic infiltrate at the interface between the epithelium and the connective tissue, focal areas of hyper-keratinized epithelium (which give rise to the clinically apparent Wickham’s striae) and occasional areas of atrophic epithelium where the rete pegs may be shortened and pointed (a characteristic known as saw tooth rete pegs). Eosinophilic colloid bodies (Civatte bodies), which represent degenerating keratinocytes, are often visible in the lower half of the surface epithelium. Degeneration of the basal keratinocytes and disruption of the anchoring elements of the epithelial BM and basal keratinocytes (e.g., hemi desmosomes, filaments, fibrils) weaken the epithelial connective tissue interface. As a result, histologic clefts (Max–Joseph spaces) may form and blisters on the oral mucosa (bullous LP) may be seen at clinical examination. B cells and plasma cells are uncommon findings.
Diagnosis
Physical examination due to its appearance.
A punch biopsy of skin
Treatments
Lichen planus is not a curable condition.
Fortunately, oral lichen planus causes few problems and treatment is not usually required. Oral hygiene can be poor among people with oral pain, which makes it even more important to maintain good oral hygiene.
In needed cases, treatment for lichen planus may include antihistamines, phototherapy, or steroid creams/tablets.
Antihistamines may be used to treat itching in severe cases of lichen planus.
For lichen planus that occurs in the mouth, steroid lozenges are used or mouthwashes if mouth ulcer symptoms become uncomfortable.
Corticosteroids will be needed in severe cases as tablets.
Prognosis
Usually, mild lichen planus on the skin clears up on its own in some months to years.
Moderate cases subside within some weeks to months with treatment.
Some cases where the disease affects mucous membranes are resistant to treatment and prone to recur.
Complications
Permanent brown or grey marks on the skin
In rare cases, persistent skin lesions and mouth ulcers may increase the risk of developing cancer by a small amount.
Disease & Ayurveda
Charmakushtha
Nidana
Unwholesome diet with opposite potency
Improper routine and behaviour
Teasing and humiliating other good people
Theft
Bad deeds which cause emotional stress factors like repentance/fear/anxiety
Kapha-Vaatadoshakopanidana – causes for vitiation of all the kapha and Vaatadosha
Purvaaroopa
Absence of sweating
Loss of tactile sensation
Samprapti
Due to the causative factors, vitiated doshas (mainly kapha& Vaata) vitiate rasadhatu and reaches skin. It settles on the skin and develop into thick and hard skin rashes.
Lakshana
Hasticharma – thick skin like that of elephant
Kharasparsam – Hard/rough to touch
Divisions
Not mentioned
Prognosis
Akrichram or yaapyam
Chikithsa
Samana
Pralepa with lekhanadravya
External application of ghrita after aamapachana
Gandoosha/Kabalagraha
Sodhana
Snehana
Swedana
Nasya
Dhoomapana
Virechana
Ksharakarma
Commonly used medicines
Patolamooladi kashayam
Gulguluthiktakam Kashayam
Gandhak Rasayan
Madhusnuhi Rasayan
Thriphalachoornam
Arogyavardhini vati
Brands available
AVS Kottakal
AVP Coimbatore
Vaidyaratnam oushadhasala
Home remedies
While lichen cannot be cured, some home remedies have been said to relieve symptoms.
Turmeric has been suggested as a remedy for oral lichen planus as it has shown effects on the immune system that could help reduce the inflammation that contributes to the condition.
A recent pilot study demonstrated promising results for this herbal treatment.
Other suggested treatments include:
- applying certain oats, to the skin
- chewing sage
- applying aloe vera gels to the skin
- essential oils
- borax
However, there appears to be little to no evidence supporting the safety and effectiveness of these treatments.
It is better to follow a course of treatment prescribed by a medical professional.
Diet
- To be avoided
Red meat, fried non-veg items, and sea foods
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods and spicy food- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, buttermilk boiled with turmeric, ginger and curry leaves
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Avoid sedentary lifestyle. Be active.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid forcing or holding of natural urges like urine, faeces, vomiting, hiccups etc.
Avoid Stress and emotional imbalance as much as possible.
Yoga
Ardha mathsyentra asanam
Halasanam
Vakrasanam
Dhanurasanam
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541468/