Lichen Planus - Symptoms

Lichen planus can be easily identified in most cases because of the typical location of rashes and their 'violaceous' appearance.

The skin eruptions of lichen planus tend to involve the following areas:

Insides of the wrists

Ankles

Lower back

Scalp

 

Nails

Mucous membranes that line the mouth. nose, genitals
(vagina / penis) and anus

The onset of eruptions can be sudden or gradual, and they show the following features:

• rows or small clusters of flat-topped eruptions, usually a few millimeters in diameter;
• violet colour of rashes in most cases; the colour may vary from purple to pink to red;
• itching, which may vary from mild to severe;
• new eruptions may appear at the sites of minor skin injury, such as a superficial scratch (called as Koebner's phenomenon);
• in some cases, there may be thick, reddish-brown lesions that are covered with scales (called as hypertrophic lichen planus);
• when the rashes resolve, they leave behind dark brown or grey spots (hyperpigmentation marks);
• in cases of scalp involvement, there can be a development of scarring in the affected areas, leading to loss of hair; and
• affected nails may develop pits and grooves.

Oral lichen planus has a typical presentation that involves the following:

• small, pale, raised areas that form a lacy network on the inside of the cheeks, rarely involving the tongue (occasionally, the lesions may be red and shiny);
• soreness, burning pain, tenderness, especially while having spicy foods;
• dry mouth with metallic taste or blunted-taste sensation; and
• painful, recurrent ulcers in the mouth.

People with long-term lesions of oral lichen planus are at a greater risk of developing malignancy (squamous cell carcinoma).