Is Lichen Planus Serious?

Lichen planus (LP) is chronic inflammatory condition in the skin and mucous membranes. The exact cause it not known but believe to be an autoimmune disease and there are several factors know to stimulate immune system to cause lichen planus. There is no cure for lichen planus. Medications such as retinoids, corticosteroids, and antihistamines can be given to control the symptoms.

Lichen planus is usually a self-limiting disease; however, there are several complications that can occur and some of these complications are serious. To answer the question whether the lichen planus is serious:

Lichen planus is a self-limiting skin disease and remission occurs after some time with treatment. Flareups can occur from time to time. Even after the lesions are clear the skin may remain discolored (brown or gray) as a result of post-inflammatory hyperpigmentation. This is seen well in dark skin people.

Cutaneous lichen planus can occur on the genital skin such as the vulva, inside of the vagina, or over the penile or scrotal skin. In erosive lichen planus, ulcers develop in these sites and this leads to severe pain and burning sensation.

Even in the oral cavity this erosive lichen planus can develop it will also cause pain and soreness in the mouth with food and drink. This will affect the quality of life.

These cutaneous ulcers and mouth ulcers can also cause secondary bacterial and fungal infections as well.

The lichen planus lesions that affect the scalp may present as reddish plaques surrounding hair follicles, with itching and scaling. This may cause scarring and hair loss.

Dyspareunia is painful sexual intercourse. When these lichen planus lesions are painful especially the erosive type it may cause severe pain during intercourse and this will reduce the pleasure and satisfaction. If infections also develop on top of the erosive ulcers, it will be very painful during sexual intercourse.

Vulval or vaginal erosions can be extensive and the outcome is often scarring of the vulva or the vaginal which may lead to:

• Labial fusions
• Urethral narrowing
• Obstruction and pain during urination
• Dyspareunia
• Closing of the vaginal or vulval opening.

Esophageal lichen planus is quite rare however it can lead to swallowing difficulties (dysphagia) and later esophageal narrowing (esophageal strictures). This will lead to malnutrition, weight loss and aspiration pneumonia. Since this lichen planus type is rare it’s usually misdiagnosed and therefore not treated properly leading to the above complications.

The erosive lichen planus can cause problems in many functions of the body. It causes difficulty in eating, drinking, swallowing, urination, defecation and sexual intercourse. This will affect the quality of life. There are evidences that the severe pain and discomfort can cause stress, anxiety and may even lead to depression.

Oral and cutaneous erosive lichen planus has increased risk of malignant transformation. Only about 2% cases are reported. Lesions that occurred in the vulva, penis, in the oral cavity may become ulcerated. When these ulcers persist for a long time they may transfer into malignancy and cause penile, vulval and oral cavity cancers usually the squamous cell carcinoma.

It is important you seek medical advice:

• If there is change in the appearance of the lesion
• Lichen planus which does not cure with proper medical treatment
• If there is sudden pain or soreness develop within the lesion
• If you have other risk factors for development of cancer e.g. if you chew tobacco, smoke when you have oral lichen planus lesion.

It is important you go for regular checkups so that malignant lesions can be identified early.

Lichen planus is a self-limiting disease however there are several complications and some of them can be serious. The complications that can occur are skin hyperpigmentation, erosive lichen planus, scarring alopecia, dyspareunia, scarring of female genital tract, esophageal stensosis, psychological problems and malignant transformation. Dyspareunia, Scarring of female genital tract, the erosive lichen planus and esophageal stenosis can affect the quality of life whereas malignant transformation can give rise to oral, vulval and penile cancers.

Also Read:

• Lichen Planus: Causes, Risk Factors, Signs, Symptoms, Investigations, Treatment