Health A to Z
Lichen planus is a non-infectious, itchy rash that can affect many areas of the body.
Affected areas can include the:
Read more about the symptoms of lichen planus.
The exact cause of lichen planus is unknown. However, the condition isn't infectious and doesn't usually run in families. It can't be passed on to other people, including sexual partners.
Read more about the causes of lichen planus.
A GP can usually diagnose lichen planus by examining the rash and asking about your symptoms. Oral lichen planus is often diagnosed by a dentist during routine dental check-ups.
Read more about diagnosing lichen planus.
Lichen planus is thought to affect 1-2% of the worldwide population. It's more common in adults over the age of 40.
Lichen planus of the skin affects men and women equally. However, oral lichen planus is more common in women. The mouth is affected in around 50% of all cases of lichen planus (oral lichen planus).
There's no single treatment that can cure lichen planus completely. However, treatments are available to help manage the symptoms and make living with it easier. For example, steroid creams or ointments are often used to help relieve the itch and control the rash.
Most cases of lichen planus of the skin clear up on their own within six to nine months. The rash rarely lasts longer than 18 months. However, oral lichen planus and lichen planus that affects the genital area may be more persistent.
Read more about how lichen planus is treated.
Erosive lichen planus is a rare form of lichen planus that can last a long time. It causes painful ulcers to develop in the mouth and in the genital areas of both males and females.
In some cases, long-term erosive lichen planus can increase the chance of some types of cancer developing.
Read our page on complications of lichen planus for more information about erosive lichen planus.
The symptoms of lichen planus vary, depending on which area of the body is affected.
Areas of the body most commonly affected by the condition include the:
The symptoms of lichen planus of the skin are:
Lichen planus of the skin often affects the wrists, ankles and lower back, although other parts of the body can also be affected.
Thickened (hypertrophic) lichen planus affects the shins, and ring-shaped lichen planus affects creases in the skin, such as the armpits.
After the papules have cleared, the affected area of skin can sometimes become discoloured.
The symptoms of oral lichen planus are:
Mild cases of oral lichen planus don't usually cause any pain or discomfort.
The symptoms of lichen planus of the penis are:
The symptoms of lichen planus of the vulva and vagina include:
Lichen planus can sometimes affect other areas, including:
The cause of lichen planus is unknown.
It's thought to be related to the immune system, or an abnormal response of the immune system to certain medicines.
Lichen planus isn't infectious, doesn't usually run in families and can't be passed on to others.
The immune system protects your body against illness and infection by producing antibodies (proteins) that attack bacteria and viruses.
In people with lichen planus, it's thought that the immune system becomes overactive, causing an excess amount of proteins to be produced, which inflame the skin. This is known as an autoimmune reaction and causes the symptoms of lichen planus.
A reaction to certain medications is another possible cause of lichen planus. For example:
Lichen planus is often diagnosed by a GP or dentist examining the affected area.
Your GP may be able to make a diagnosis based on the characteristic rash. However, lichen planus can be mistaken for other skin conditions, such as eczema, which also causes the skin to become red, flaky and itchy.
If your doctor is unable to make a confident diagnosis by examining your skin, they may want to take a small skin sample (biopsy), which will be examined under a microscope.
If a skin biopsy is required, you'll be given a local anaesthetic to numb the affected area so you don't feel any pain or discomfort during the procedure.
A dentist or doctor can diagnose oral lichen planus by looking at the inside of your mouth.
A biopsy may be recommended to confirm the diagnosis. A sample of mouth tissue will be removed so that it can be examined under a microscope. As with lichen planus of the skin, you'll be given a local anaesthetic to numb the pain.
There's no cure for lichen planus, so treatments aim to ease the symptoms and clear the rash. Mild lichen planus doesn't require treatment.
Below is some general self-help advice that can help ease your symptoms and prevent them getting worse.
There are a number of medications and treatments that may be recommended for lichen planus of the skin, hair and nails. These are outlined below.
Corticosteroid creams and ointments contain corticosteroids (artificial hormones) and are used to treat inflammatory skin conditions. They are often referred to as topical corticosteroids.
Topical corticosteroids help treat the swelling (inflammation) and redness caused by lichen planus. Strong topical corticosteroids, such as clobetasol propionate, are also effective in reducing any itchiness you may have.
Treatment is applied to the red or purple itchy spots, but should be stopped when the colour of the rash changes to brown or grey. This pigment change occurs when the inflammation has settled. Continuing to apply the corticosteroid cream to the brown areas of skin will gradually cause the skin to thin.
The side effects of corticosteroids can vary, depending on the:
Potential side effects of topical corticosteroids can include:
Always check the patient information leaflet that comes with your medicine.
Corticosteroid tablets are sometimes used to treat severe cases of lichen planus, when the symptoms aren't being effectively controlled with creams or ointments.
Possible side effects of corticosteroid tablets used on a short-term basis can include:
Read more about the side effects of corticosteroids.
Other treatments recommended for lichen planus of the skin are outlined below.
Mild cases of oral lichen planus won't need any treatment. In more severe cases, treatment includes:
In more severe cases of oral lichen planus, corticosteroid tablets (see above) may also be used on a short-term basis.
It can be difficult to prevent oral lichen planus, but to keep the lining of your mouth healthy it's recommended that you:
You should also maintain good oral hygiene by cleaning your teeth at least twice a day, and having regular dental check-ups, so that any problems with your teeth or mouth can be identified and treated early.
If corticosteroids are not effective in treating your symptoms, you may be prescribed a medication that suppresses your immune system to try to limit the autoimmune reaction that's thought to cause lichen planus.
These types of treatments are known as immunomodulating agents. Depending on which area of your body is affected by lichen planus, treatments that may be recommended for you can include: treatments such as tacrolimus
These treatments can cause a number of different side effects, which your specialist can discuss with you.
You'll also need to have regular blood tests while taking immunomodulating agents, particularly in the early stages of treatment.
Complications of lichen planus may include discoloured skin and, in some cases, erosive lichen planus may develop into certain types of cancer.
After the lichen planus rash has cleared up, the affected area of skin may be a different colour to what it was originally. There may be a brown or grey mark, which can sometimes last for months. This is known as post-inflammatory hyperpigmentation, and tends to be more noticeable in people with darker skin.
Erosive lichen planus is a long-lasting (chronic) form of lichen planus that causes painful ulcers to develop, as well as burning and discomfort in the genital areas of both male and females.
Occasionally, in around 2% of cases, long-term cases of erosive lichen planus can develop into certain types of cancer, such as:
Regularly examining yourself and being aware of any changes that occur will help you to identify any problems at an early stage. Pay close attention to ulcerated areas in your mouth or genitals that don't heal and persist for a long time. Visit your GP immediately if you notice any changes that you're concerned about.
You should also visit your dentist regularly to ensure that your teeth and gums remain healthy, and that any ulcers or patches that form in your mouth are examined and treated promptly. Depending on individual circumstances, dental check-ups for adults are recommended anywhere between every 3 to 24 months.
Read more about treating lichen planus, including self-help tips for managing all types of the condition.
Dale Hodgson was diagnosed with oral lichen planus when she was 44, and has learnt to adapt her lifestyle to cope.
"I remember waking up one morning in May 1995, when I was 44, and my mouth felt scalded, like I'd eaten something that had burnt it. When I went into the bathroom to have a look in the mirror, I was horrified by what I saw. The inside of my mouth was bright red, including my gums and tongue.
"I immediately booked an appointment with my GP. I was in agony. I could hardly eat or drink anything, and cleaning my teeth was incredibly painful.
"After seeing both my GP and dentist, I was eventually referred to an oral consultant and maxillofacial surgeon, as neither knew what was wrong with me.
"My consultant was brilliant. As soon as I opened my mouth, he told me he thought it was oral lichen planus. He made me up lots of lidocaine mouthwash, which acts as an anaesthetic, so I could eat and clean my teeth without pain.
"I had a biopsy and the results confirmed I had lichen planus. My consultant gave me some oral steroids to take for 10 days. These took away some of the discomfort by reducing the soreness and swelling, but they're not a cure.
"After this treatment, I was given a steroid spray to use four times a day. No one really knows what causes lichen planus, but both my consultants were positive that stress aggravates it. It's true that when I'm stressed, I have a particularly horrendous time with my mouth.
"I reached a point where I decided to stop taking steroids for my lichen planus. I didn't want to keep taking them when they weren't making a huge difference. The inside of my mouth is covered in white streaks and patches that are sore all the time, but I try not to think about it and have learnt to live with the condition.
"There are certain foods I haven't been able to eat since I was diagnosed. Anything crunchy or crispy will cut my mouth and give me lesions, and citrus foods will bring me up in blood blisters. Spicy foods and mint leave me in agony, but I just work round it and eat other things instead.
"I just get on with life. I try to chill out and keep my stress levels down by going for massages and doing yoga. After all, there are people out there with worse things."
Bridget Nelson was diagnosed with a painful, erosive form of lichen planus that affected her mouth and vulva.
Today, she's relatively pain-free and keeps her condition under control with steroid treatments.
"My problems started with an initial flare-up of vulval pain on Christmas Eve 2003, when I was 42, although looking back I'd had mouth soreness and ulceration for about a year before this.
"I thought I had an infection and went to see my GP, who treated me for thrush, but the problem remained. I then had an MRI scan, swabs, a gynaecological scan and X-rays of my lumbar area (spine), but none of the tests showed anything abnormal and the doctors didn't know what was wrong.
"I began to give up hope and got very depressed. Every time I went to see my GP, my flare-up had flared down and there was nothing much to see. In the end I took photographs of my vulva when it had flared up, and showed these to my GP. I got a referral to a dermatologist, and was finally diagnosed with vulval and oral erosive lichen planus.
"I started treatment at the end of July 2005 with a high-potency topical steroid (ointment) for my vulva and a steroid spray for my mouth. It took about four months before my lichen planus was under control with the treatment.
"In the meantime, I was in so much pain I wasn't able to go on long car journeys and had to give up my office-based job, which involved a lot of sitting at a computer. I felt too embarrassed to tell anyone about my condition and a complete failure for not being strong enough to hold down a job.
"I couldn't wear trousers or tights, and sometimes even knickers were too painful against my skin. I mainly wear skirts and stockings now. I also can't take baths, only showers, and without any perfumed shower gels.
"After a while I got to know what triggered my flare-ups: stress and sitting for any length of time. I learnt to avoid these as much as possible, although I sometimes flare up for no reason at all.
"My partner and I had a difficult time together, but he stayed with me and we have adapted with the condition. We're now happier than ever.
"Now my condition is managed really well with a steroid cream called Dermovate, which is for the vulva, and an oral steroid for the mouth lesions. I am mainly free from flare-ups and pain.
"In November 2007, I set up the charity UK Lichen Planus to provide clear, up-to-date information for other people with the condition and give them some much-needed support."