Lichen planus

Lichen planus is a condition that forms a very itchy rash on the skin or in the mouth.

The exact cause of lichen planus is unknown. It may be related to an allergic or immune reaction.

Risks for the condition include:

Exposure to certain medicines, dyes, and other chemicals (including gold, antibiotics, arsenic, iodides, chloroquine, quinacrine, quinine, phenothiazines, and diuretics)
Diseases such as hepatitis C
Hepatitis C
Hepatitis C is a viral disease that leads to swelling (inflammation) of the liver. Other types of viral hepatitis include:Hepatitis AHepatitis BHepat...
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Lichen planus mostly affects middle-aged adults. It is less common in children.

Symptoms

Mouth sores are one symptom of lichen planus. They:

May be tender or painful (mild cases may not cause pain)
Are located on the sides of the tongue, inside of the cheek, or on the gums
Look like bluish-white spots or pimples
Form lines in a lacy network
Gradually increase in size
Sometimes form painful ulcers
Ulcers
An ulcer is a crater-like sore on the skin or mucous membrane. Ulcers form when the top layers of skin or tissue have been removed. They can occur ...
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Skin sores are another symptom of lichen planus. They:

Usually appear on the inner wrist, legs, torso, or genitals
Are extremely itchy
Have even sides (symmetrical) and sharp borders
Occur alone or in clusters, often at the site of a skin injury
May be covered with thin white streaks or scratch marks
Are shiny or scaly looking
Have a dark, violet color
May develop blisters or ulcers
Blisters
A vesicle is a small fluid-filled blister on the skin.
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Other symptoms of lichen planus are:

Dry mouth
Hair loss
Metallic taste in the mouth
Ridges in the nails

Exams and Tests

Your health care provider may make the diagnosis based on the appearance of your skin or mouth lesions.

A skin lesion biopsy or biopsy of a mouth lesion can confirm the diagnosis.

Treatment

The goal of treatment is to reduce symptoms and speed healing. If your symptoms are mild, you may not need treatment.

Treatments may include:

Antihistamines
Medicines that calm down the immune system (in severe cases)
Lidocaine mouthwashes to numb the area and make eating more comfortable (for mouth sores)
Topical corticosteroids or oral corticosteroids to reduce swelling and lower immune responses
Corticosteroid shots into a sore
Vitamin A as a cream or taken by mouth
Other medicines that are applied to the skin
Dressings placed over your skin with medicines to keep you from scratching
Ultraviolet light therapy

Outlook (Prognosis)

Lichen planus is usually not harmful. Most often, it gets better with treatment. The condition often clears up within 18 months, but may come and go for years.

If lichen planus is caused by a medicine you are taking, the rash should go away once you stop the medicine.

Possible Complications

Mouth ulcers that are present for a long time may develop into oral cancer.

When to Contact a Medical Professional

Contact your provider if:

Your skin or mouth lesions change in appearance
The condition continues or gets worse, even with treatment
Your dentist recommends changing your medicines or treating conditions that trigger the disorder

Open References

References

James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Lichen planus and related conditions. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 12.

Patterson JW. An approach to the interpretation of skin biopsies. In: Patterson JW, ed. Weedon's Skin Pathology. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 2.

Lichen planus - close-up - illustration
Lichen planus is an intensely itchy (pruritic) inflammatory lesion of the skin. The lesions are generally violaceous (red-purple), slightly raised bumps (papules) with fine scales. The papules may run together (coalesce) to form a larger raised surface (plaque). This is a condition usually seen in adults, although it can occur in children.
Lichen planus - close-up
illustration
Lichen nitidus on the abdomen - illustration
Lichen nitidus consists of tiny flesh colored to pink raised lesions (papules). The papules are asymptomatic but persist for long periods of time. They generally occur only on the abdomen, flexor surfaces of the elbows and palms, and on the male genitalia.
Lichen nitidus on the abdomen
illustration
Lichen planus on the arm - illustration
The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham's striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age.
Lichen planus on the arm
illustration
Lichen planus on the hands - illustration
The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham's striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age. This is a less common variant, shown here with scales.
Lichen planus on the hands
illustration
Lichen planus on the oral mucosa - illustration
Oral lichen planus occurs in about half of the people who have lichen planus on their skin. It consists of painless, whitish streaks on the mucous membranes. This may also produce ulcers, which are usually painful.
Lichen planus on the oral mucosa
illustration
Lichen striatus - close-up - illustration
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously (without medication) over a period of months. This condition is seen frequently in children less than 16 years old, but may also occur in adults.
Lichen striatus - close-up
illustration
Lichen striatus on the leg - illustration
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. It clears over a period of months without needing treatment. This condition is seen frequently in children less than 16 years old but, also occurs in adults.
Lichen striatus on the leg
illustration
Lichen striatus - close-up - illustration
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously over a period of months. This condition is seen frequently in children less than 16 years old, but also occurs in adults.
Lichen striatus - close-up
illustration

Lichen planus - close-up - illustration
Lichen planus is an intensely itchy (pruritic) inflammatory lesion of the skin. The lesions are generally violaceous (red-purple), slightly raised bumps (papules) with fine scales. The papules may run together (coalesce) to form a larger raised surface (plaque). This is a condition usually seen in adults, although it can occur in children.
Lichen planus - close-up
illustration
Lichen nitidus on the abdomen - illustration
Lichen nitidus consists of tiny flesh colored to pink raised lesions (papules). The papules are asymptomatic but persist for long periods of time. They generally occur only on the abdomen, flexor surfaces of the elbows and palms, and on the male genitalia.
Lichen nitidus on the abdomen
illustration
Lichen planus on the arm - illustration
The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham's striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age.
Lichen planus on the arm
illustration
Lichen planus on the hands - illustration
The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham's striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age. This is a less common variant, shown here with scales.
Lichen planus on the hands
illustration
Lichen planus on the oral mucosa - illustration
Oral lichen planus occurs in about half of the people who have lichen planus on their skin. It consists of painless, whitish streaks on the mucous membranes. This may also produce ulcers, which are usually painful.
Lichen planus on the oral mucosa
illustration
Lichen striatus - close-up - illustration
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously (without medication) over a period of months. This condition is seen frequently in children less than 16 years old, but may also occur in adults.
Lichen striatus - close-up
illustration
Lichen striatus on the leg - illustration
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. It clears over a period of months without needing treatment. This condition is seen frequently in children less than 16 years old but, also occurs in adults.
Lichen striatus on the leg
illustration
Lichen striatus - close-up - illustration
Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously over a period of months. This condition is seen frequently in children less than 16 years old, but also occurs in adults.
Lichen striatus - close-up
illustration

A Closer Look

Self Care

Tests for Lichen planus

Review Date: 11/18/2022

Reviewed By: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

Lichen planus

Rash

Hepatitis C

Symptoms

Mouth sores

Ulcers

Blisters

Exams and Tests

Skin lesion biopsy

Treatment

Outlook (Prognosis)

Possible Complications

Mouth ulcers

Oral cancer

When to Contact a Medical Professional

References

Lichen planus - close-up - illustration

Lichen planus - close-up

Lichen nitidus on the abdomen - illustration

Lichen nitidus on the abdomen

Lichen planus on the arm - illustration

Lichen planus on the arm

Lichen planus on the hands - illustration

Lichen planus on the hands

Lichen planus on the oral mucosa - illustration

Lichen planus on the oral mucosa

Lichen striatus - close-up - illustration

Lichen striatus - close-up

Lichen striatus on the leg - illustration

Lichen striatus on the leg

Lichen striatus - close-up - illustration

Lichen striatus - close-up

Lichen planus - close-up - illustration

Lichen planus - close-up

Lichen nitidus on the abdomen - illustration

Lichen nitidus on the abdomen

Lichen planus on the arm - illustration

Lichen planus on the arm

Lichen planus on the hands - illustration

Lichen planus on the hands

Lichen planus on the oral mucosa - illustration

Lichen planus on the oral mucosa

Lichen striatus - close-up - illustration

Lichen striatus - close-up

Lichen striatus on the leg - illustration

Lichen striatus on the leg

Lichen striatus - close-up - illustration

Lichen striatus - close-up

A Closer Look

Self Care

Tests for Lichen planus

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