Lichen Planus is a skin disease thought to be caused by an immune system disorder. It isn’t solely a genital disease and can occur in other areas of the body such as the mouth, gums, wrists, lower back, ankles, external ear canal and eyelids.
Genital lichen planus can occur at the vulva, outer labia and even internally in the vagina. Men can have it too. It can affect their penis and scrotum.
The rash looks reddish purple with fine white lines in it. This is called Wickham's striae and is caused by excessive scratching. The rash spreads gradually and is incredibly itchy. Sometimes the rash develops into painful ulcers.
Other symptoms include:
• Metallic taste in the mouth.
• Ridges in the nails.
• Hair loss.
• Dry mouth.
• Lichen planus in the vagina results in the surface skin peeling off, discharge and bleeding on contact.
• Lichen planus on the vulva or labia causes a bright red, painful rash. The affected labia can shrink and stick together and ulcerated areas can scar. Scar tissue can block off the vagina. If this happens, the woman will need an operation called the Fenton’s procedure to remove scar tissue.
• Lichen planus on the penis usually occurs as a pimple like rash around the tip of the penis.
What causes it?
Doctors aren’t sure, but it occurs more commonly after exposure to medications, including antibiotics. According to Medline Plus, it is likely to be related to an allergic or immune reaction.
Exposure to metals such as gold can also cause it, and to toxic chemicals and dyes. Sometimes it can develop as a complication of Hepatitis C.
Diagnosis is fairly simple as the doctor can see by examining you whether you have lichen planus. A biopsy (small amount of tissue) will be taken to confirm this. A blood test may be done to rule out Hepatitis C.
Treatments vary, but may be:
• Antihistamines to relieve itching.
• Oral or topical corticosteroids to suppress the immune system that has gone awry, and to reduce swelling.
• Other immune-suppressant medicines (these carry a risk of cancer so you will be monitored for this if you choose to have this type of treatment)
• Vitamin A cream – to reduce swelling and itching and encourage healing
• In severe cases, surgery to remove scar tissue.
• Acitretin – a medicine to treat skin diseases. If you are female, this medication can harm a developing fetus and you should NOT get pregnant for three years after taking this drug, so if you want a family soon, this is not the treatment for you. Acitretin has also been found in semen after men have taken it and it isn’t known whether conception with affected sperm would damage the fetus.
Mild cases don’t usually need treatment as the disease resolves by itself after 18 months or less. However, if you’ve had it once it may come back again in bouts.
Lichen planus, Medline Plus. Web. 7 March 2012. http://www.nlm.nih.gov/medlineplus/ency/article/000867.htm
Lichen planus, Derm Net NZ. Web. 7 March 2012. http://www.dermnetnz.org/scaly/lichen-planus.html
Fenton’s Procedure, Cambridge University Hospitals NHS Trust. Web. 7 March 2012. http://www.cuh.org.uk/resources/pdf/patient_information_leaflets/PIN0177_fentons.pdf
Acitretin, Medline Plus. Web. 7 March 2012. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601010.html
Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/. She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting.
Reviewed March 8, 2012
by Michele Blacksberg RN
Edited by Jody Smith