Lichen Planus

Overview

Characterized by inflammation of the mucous membranes in the mouth and of skin cells, resulting in the swelling and irritation of the skin, mouth, scalp, nails, and genitals.

Common Symptoms

Shiny purple flat bumps occurring on the forearm, wrists, or ankles, lacy patches of white dots in the mouth, hair loss, changes in scalp color, nail damage or loss, and sores in the mouth or genitals.

Coexisting Diseases and Conditions

Hepatitis C, vitiligo, multiple sclerosis, alopecia areata, ulcerative colitis, autoimmune thyroid diseases, psoriasis, Sjogren’s syndrome, and dermatomyositis.

Risk Factors and Prevalence

Males and females both are equally likely to get lichen planus of the skin, however, oral lichen planus is more common in females. The condition is also more likely to develop in middle-aged adults. Studies have linked the usage of certain medications such as painkillers in causing lichen planus.

 

 

Lichen Planopilaris/Follicular Lichen Planus

Lichen Planopilaris (LPP) is a variant of Lichen Planus in which T-lymphocytes attack hair follicles. This causes permanent hair loss and scarring. There are three types of LPP: classic lichen planopilaris, frontal fibrosing alopecia, and Lassueur-Graham-Little-Piccardi syndrome. The main difference between the three is the location of hair loss.

Three types of LPP:

Classic lichen planopilaris
causes inflammation, scarring, and bald patches on the scalp.
Frontal fibrosing alopecia (FFA)
causes scarring and hair loss at the hairline and eyebrows. FFA most commonly occurs in post-menopausal women and particularly women of African American descent. It is thought that genetics and environmental exposures may play a role in the development of FFA.
[source] Most commonly occurs in post-menopausal women and particularly women of African American descent[source] genetics[source] environmental exposures
Lassueur-Graham-Little-Piccardi syndrome
not only causes patchy hair loss on the scalp, but also thinning of armpit and pubic hair, and bumps around the remaining hair follicles. It is four times more common in women than men.
[source] four times more common in women

LPP is most common in women between 40 and 60 years old but can also occur in other ages and in men. It is hypothesized that exposure to certain sensitizing agents (metals, bacterial infections, drugs) may play a role in the development of LPP. Half of the people with LPP go on to develop Lichen Planus. 

Sources

  1. Article Sources

    1. Mayo Clinic Staff. (2021, March 9). Lichen planus. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/lichen-planus/symptoms-causes/syc-20351378.

    2. Petti, S., Rabiei, M., De Luca, M., & Scully, C. (2011). The magnitude of the association between hepatitis C virus infection and oral lichen planus: meta-analysis and case control study. Odontology, 99(2), 168–178. https://doi.org/10.1007/s10266-011-0008-3.

    3. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. (n.d.). Lichen Planus. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/lichen-planus#:~:text=Lichen%20planus%20usually%20affects%20men,very%20young%20or%20very%20old. 

    4. Thompson, D. F., & Skaehill, P. A. (1994). Drug-induced lichen planus. Pharmacotherapy, 14(5), 561–571.

    5. Weston, G., & Payette, M. (2015). Update on lichen planus and its clinical variants. International journal of women’s dermatology, 1(3), 140–149. https://doi.org/10.1016/j.ijwd.2015.04.001.