7 Common Lichen Planus Symptoms You Should Know

Lichen planus is an inflammatory condition that affects the skin, mucous membranes, nails, and hair. This immune system disorder can cause discomfort and concern for those affected. While the exact cause remains unclear, understanding the symptoms is crucial for early identification and proper management. This comprehensive guide explores the most common signs and symptoms of lichen planus to help you recognize this condition.

1. Purple or Reddish-Purple Bumps on the Skin

The most characteristic symptom of lichen planus is the appearance of flat-topped, shiny bumps on the skin. These lesions typically present as purple or reddish-purple papules, though they may appear darker on individuals with darker skin tones.

The bumps usually measure between 2-4 millimeters in diameter and have a distinctive polygonal (angular) shape with well-defined borders. They most commonly appear on the inner wrists, forearms, legs, ankles, and lower back, though they can develop anywhere on the body.

One distinctive feature is the presence of fine white lines or scales on the surface of these bumps, known as Wickham’s striae. These are best visible under magnification or when the skin is moistened. The affected areas may be intensely itchy, though some people experience minimal discomfort.

2. Oral Lesions and White Patches

Oral lichen planus is one of the most common forms of this condition, affecting the mucous membranes inside the mouth. It presents as white, lacy patches or lines on the inside of the cheeks, tongue, gums, or lips.

These oral lesions can take several forms:

• Reticular pattern: The most common type, appearing as white, web-like lines or streaks
• Erosive pattern: Painful red, ulcerated areas that may bleed when touched
• Plaque-like pattern: White, raised patches similar to those seen in oral thrush
• Bullous pattern: Fluid-filled blisters that may rupture

People with oral lichen planus may experience burning sensations, sensitivity to hot or spicy foods, and difficulty eating or speaking during flare-ups. The erosive form can be particularly painful and may require medical attention.

3. Intense Itching and Discomfort

Pruritus, or severe itching, is a hallmark symptom of cutaneous lichen planus. The intensity of itching can range from mild to severe, and it often becomes worse at night, potentially disrupting sleep.

The itching sensation may be described as:

• Persistent and nagging
• Burning or stinging in nature
• Accompanied by a tingling sensation
• Worsened by heat, stress, or friction

Scratching the affected areas can lead to the Koebner phenomenon, where new lesions develop along scratch lines or areas of skin trauma. This can result in a linear pattern of bumps and further spread of the condition. The itch-scratch cycle can also lead to skin thickening and darkening over time, a condition called lichenification.

4. Nail Changes and Deformities

Approximately 10% of people with lichen planus experience nail involvement, which can affect one or multiple nails on the fingers or toes. Nail changes may occur with or without skin lesions.

Common nail symptoms include:

• Thinning: Nails become brittle and fragile
• Ridging: Longitudinal grooves or ridges develop along the nail plate
• Splitting: The nail may split or develop fissures
• Color changes: Nails may become discolored or develop reddish-brown streaks
• Pterygium: The cuticle grows forward onto the nail plate
• Complete nail loss: In severe cases, permanent destruction of the nail matrix can occur

Nail lichen planus can be particularly distressing and may cause functional difficulties with fine motor tasks. Early recognition and management are important to prevent permanent nail damage.

5. Scalp Involvement and Hair Loss

Lichen planopilaris is a variant that affects the scalp, targeting the hair follicles. This form can lead to scarring alopecia, resulting in permanent hair loss if not addressed promptly.

Symptoms of scalp lichen planus include:

• Redness and inflammation around hair follicles
• Scaling and flaking of the scalp
• Tenderness or burning sensation on the scalp
• Progressive patches of hair loss
• Smooth, shiny areas where hair has been lost
• Visible follicular plugs or scale around hair shafts

The hair loss typically occurs in a patchy distribution and may be accompanied by itching or pain. Unlike other forms of lichen planus, scalp involvement requires prompt attention as the scarring can lead to irreversible hair loss.

6. Genital Lesions

Lichen planus can affect the genital area in both men and women, though it’s more commonly recognized in women. Genital lichen planus can cause significant discomfort and may impact quality of life.

In women, symptoms may include:

• White streaks or erosions on the vulva
• Burning or stinging sensations
• Pain during intercourse (dyspareunia)
• Vaginal discharge
• Bleeding after intercourse
• Adhesions or scarring in severe cases

In men, genital lichen planus typically presents as:

• Purple or white lesions on the glans or shaft of the penis
• Ring-like patterns around the corona
• Itching or discomfort
• Difficulty retracting the foreskin in uncircumcised men

Genital lichen planus can be mistaken for other conditions, making proper diagnosis essential for appropriate management.

7. Skin Discoloration After Healing

Even after the active lesions of lichen planus resolve, many people experience persistent changes in skin pigmentation. This is known as post-inflammatory hyperpigmentation.

Characteristics of this symptom include:

• Dark patches: Areas where lesions were present may become darker than surrounding skin
• Brown or grayish discoloration: The color change can be particularly noticeable on lighter skin tones
• Long-lasting marks: These pigment changes can persist for months or even years after the inflammation has resolved
• More prominent in darker skin: Individuals with darker skin tones tend to experience more significant and longer-lasting hyperpigmentation

While these marks are generally harmless and will fade over time, they can be cosmetically concerning for many people. Sun exposure can darken these areas further, making sun protection an important consideration during and after healing.

Main Causes of Lichen Planus

The exact cause of lichen planus remains unknown, but research suggests it results from an abnormal immune system response where the body’s defense system attacks cells of the skin or mucous membranes. Several factors have been identified as potential triggers or contributors:

Autoimmune Response: The primary theory is that lichen planus is an autoimmune condition where T-lymphocytes mistakenly attack the basal cells of the skin or mucous membranes, causing inflammation and the characteristic lesions.

Genetic Predisposition: Some individuals may have a genetic susceptibility to developing lichen planus, though it is not directly inherited. Certain genetic markers have been associated with increased risk.

Hepatitis C Infection: There is a well-established link between hepatitis C virus infection and lichen planus, particularly in certain geographic regions. The virus may trigger the immune response that leads to lichen planus.

Medications: Certain medications can trigger a lichen planus-like reaction, including:

• Some blood pressure medications
• Antimalarial drugs
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Certain diuretics
• Some drugs used for heart conditions

Allergens and Contact Triggers: Dental materials (such as amalgam fillings), certain metals, or chemicals can trigger oral lichen planus or lichenoid reactions in susceptible individuals.

Stress: Emotional or physical stress may trigger flare-ups of lichen planus or worsen existing symptoms, though stress alone is unlikely to cause the initial development of the condition.

Other Infections: Besides hepatitis C, other viral infections have been occasionally associated with lichen planus, though the connection is less clear.

Prevention Strategies

While lichen planus cannot be completely prevented due to its uncertain causes, certain strategies may help reduce the risk of flare-ups and minimize symptom severity:

Maintain Good Oral Hygiene: Regular brushing, flossing, and dental check-ups can help reduce oral inflammation and may decrease the severity of oral lichen planus. Use a soft-bristled toothbrush and avoid harsh, irritating toothpastes.

Avoid Triggering Substances: If you’ve identified specific triggers such as certain foods (spicy, acidic, or hot foods), tobacco, or alcohol that worsen your symptoms, avoiding these can help prevent flare-ups.

Minimize Skin Trauma: Since the Koebner phenomenon can cause new lesions to form at sites of injury, protecting your skin from cuts, scratches, and excessive friction is important. Avoid scratching itchy areas despite the temptation.

Stress Management: Since stress can trigger or worsen lichen planus, incorporating stress-reduction techniques may be beneficial:

• Regular exercise
• Meditation or mindfulness practices
• Adequate sleep
• Counseling or support groups if needed

Screen for Hepatitis C: If you have lichen planus, especially oral lichen planus, discussing hepatitis C screening with your healthcare provider may be appropriate, as treating the underlying infection may improve the lichen planus.

Review Medications: If you develop lichen planus after starting a new medication, consult with your healthcare provider about whether the medication might be contributing to your symptoms and whether alternatives are available.

Protect Your Skin from Sun: Use broad-spectrum sunscreen on affected areas to prevent post-inflammatory hyperpigmentation from darkening and to protect healing skin.

Maintain Overall Health: A healthy lifestyle with a balanced diet, regular exercise, adequate hydration, and avoiding smoking may support immune system function and overall skin health.

Frequently Asked Questions

Is lichen planus contagious?

No, lichen planus is not contagious. You cannot spread it to others through physical contact, and it cannot be transmitted from person to person.

How long does lichen planus last?

The duration varies significantly between individuals. Cutaneous (skin) lichen planus often resolves on its own within 1-2 years, though it may last longer. Oral lichen planus tends to be more chronic and may persist for many years, with periods of remission and flare-ups.

Can lichen planus turn into cancer?

While rare, oral lichen planus, particularly the erosive form, has a small increased risk of developing into oral cancer (approximately 1-2% of cases). This is why regular monitoring by a healthcare provider is important for those with oral lichen planus.

What should I avoid eating if I have oral lichen planus?

Many people with oral lichen planus find that spicy foods, acidic foods (citrus fruits, tomatoes), hot beverages, crunchy or hard foods, and alcohol can irritate the lesions and worsen symptoms. Tobacco products should also be avoided.

Can lichen planus come back after it clears?

Yes, lichen planus can recur even after complete resolution. Some people experience multiple episodes throughout their lives, while others have only one occurrence. Oral lichen planus is particularly prone to chronic, recurring symptoms.

Does lichen planus affect children?

Lichen planus is uncommon in children but can occur. When it does affect children, it typically presents similarly to adults, most commonly affecting the skin. It’s less common for children to have oral involvement.

When should I see a doctor about lichen planus?

You should consult a healthcare provider if you notice unusual rashes, bumps, or lesions on your skin or in your mouth; experience persistent itching; develop painful oral sores that interfere with eating or drinking; notice changes to your nails; or experience any scalp symptoms that could lead to hair loss. Early evaluation is important for proper diagnosis and management.

Can stress make lichen planus worse?

Yes, many people report that their lichen planus symptoms worsen during periods of high stress. While stress may not cause lichen planus, it can trigger flare-ups or make existing symptoms more severe. Stress management techniques may help control symptoms.

References:

• Mayo Clinic – Lichen Planus
• American Academy of Dermatology – Lichen Planus
• NHS – Lichen Planus
• National Center for Biotechnology Information – Lichen Planus
• DermNet NZ – Lichen Planus