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Lichen Planus

Cause:
Lichen Planus is a common, pruritic, inflammatory disease of the skin, hair follicles and mucous membranes. The cause of Lichen Planus is unknown, however some Lichenoid rashes are associated with allergic reactions to medications. Exposure to gold (commonly found in popular alcoholic schnapps liquors) and the metals found in photographic film development and processing have also caused a lichen planus–type eruption. A Lichenoid drug reaction should be suspected if the eruption is photodistributed and widespread. Additionally, lichen planus has recently been associated with hepatitis C and all at-risk patients should be given a hepatitis screening test.
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Hallmark of the disease:
Pinpoint papules that expand to form small violaceous flat-topped polygonal papules with sudden onset. There is also a thick hypertrophic variant that is commonly found on the shins/lower extremities. The is also a rare and flat variant, known as atrophic lichen planus. Lichen planus can also effect the nails and scalp (also known as lichen planopilaris). Lichen planus also will tend to form on areas of skin injury/trauma. This is known as the isomorphic response or Koebner phenomena.

Treatment:
There is no cure for Lichen Planus but treatment often relieves itching and improves the appearance. Topical corticosteroid creams are effective. In more severe and widespread cases, lesions respond well to systemic corticosteroids or intralesional steroid injections. Phototherapeutic measures may also be employed successfully in recalcitrant and or severely symptomatic cases.

Dr. Crutchfield will carefully evaluate and design a treatment program most appropriate for each individual case.

Normal Course:
Two-thirds of patients with skin lesions will have Lichen Planus for 1-2 years with spontaneous clearing in the second year. One in five will have a recurrence of Lichen Planus.Oral lichen planus with ulceration must be followed meticulously to prevent the development of oral squamous cell carcinoma. In these cases it is imperative that alcohol consumption and tobacco product be avoided because they have both been associated with the increased risk of oral squamous cell carcinoma in ulcerative lichen planus.

Patient Education:
Reassure patients Lichen Planus is not contagious and treatment is often effective in relieving itching and improving the appearance of the rash until it goes away.

Nursing measures:
Obtain a complete medication history due to lichen planus-like eruptions which may occur as an allergic reaction to medication for high blood pressure, heart disease and arthritis. Additionally, a history including chemical exposure, blood transfusions, IV drug use, and gold containing adult beverages. Advise patient to minimize injury to skin as new lesions may form in damaged skin. Most importantly advise patients to inform the clinic if sores develop in the mouth.
Dr. Crutchfield recommends the following helpful Patient information:
American Academy of Dermatology: Lichen planus


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