What Causes Lichen Planus?

Lichen planus is a condition that produces lesions on the skin and mucous membranes. Some forms of the ailment also affect the hair and nails. Patients may notice they have itchy, purple lesions that spread across large areas of the body over several weeks or months. White streaks could form over the rash, and some lesions might blister. Painful ulcers may form in the mouth, and scalp discoloration and hair loss are common in cases where the disease affects the hair. In instances in which the nails are impacted, patients could experience thin, brittle nails, and nail loss may occur. Doctors are normally able to diagnose lichen planus with a visual inspection and physical examination. In rare cases, a skin biopsy may be needed. Mild cases of lichen planus usually resolve without treatment. For more advanced cases, doctors may recommend light therapy, and antihistamines, retinoids, and corticosteroids might be prescribed.

Some of the most common risk factors and causes for lichen planus are outlined below.

Certain Medications For Heart Disease And High Blood Pressure

Patients taking certain medications for heart disease and high blood pressure are at a higher risk of developing lichen planus compared to those taking other medications. For example, beta-blockers (drugs that slow the heart rate and reduce blood pressure) are widely prescribed to treat hypertension and to treat abnormal heart rhythms. They are also used to help reduce the risk of a heart attack in patients who have previously experienced one. ACE inhibitors are frequently used to prevent additional weakening of the heart in patients with congestive heart failure, and they are used to treat hypertension too. Individuals taking these drugs are at an increased risk of the oral form of lichen planus, and they frequently develop mouth sores. Studies suggest women taking ACE inhibitors or beta-blockers could be at a higher risk of developing lichen planus than male patients taking the same medications. Patients should always let their doctor know about any mouth sores or other troublesome side effects that occur while using these medicines.

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Flu Vaccine

While the flu vaccine is considered safe and effective, some patients have developed lichen planus shortly after receiving the vaccine, and the vaccine is a recognized trigger for the condition. A Japanese study conducted in 2010 discussed three case studies in which patients developed lichen planus within two weeks after receiving the flu vaccine. A study published in December 2017 examined adverse events reported on the Vaccine Adverse Event Reporting System in the United States from July 1990 to November 2014. Of the 434,943 reported adverse events during this time, twenty-three cases of lichen planus were reported, and four cases of the oral form of lichen planus were reported. The study authors noted an average patient age of forty-seven at the time of diagnosis, and more than fifty percent of the diagnosed cases were in female patients. In addition to the influenza vaccine, researchers found the hepatitis B vaccine and the Tdap (tetanus, diphtheria, and polio) vaccine were also associated with an increased incidence of lichen planus. The majority of cases were diagnosed within the first two weeks following vaccination, and some patients were diagnosed as late as 297 days post-vaccination. Individuals planning to receive any vaccine should speak with their healthcare provider about the risks and benefits of vaccination for their specific needs.

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Pain Relievers

Ibuprofen and naproxen are two of the most commonly used over-the-counter pain relievers on the market. These drugs are also available in prescription-strength versions, and they are typically used for headaches, menstrual pain, muscle aches, arthritis pain, and fever reduction. Researchers have linked both of these pain relievers to an elevated risk of lichen planus. Since the condition is more common in individuals over forty years old, these patients may want to consider taking other types of painkillers to relieve their symptoms.

Anyone thinking of using any form of over-the-counter pain reliever should carefully read the information leaflet that comes with the medication, and care needs to be taken not to exceed the recommended dosage. If the patient gets no relief from their pain after using over-the-counter medication for a week, they should see a doctor to determine the underlying cause and the appropriate treatment. The clinician may be able to recommend drug-free options such as ice packs, heating pads, or stretching exercises that could effectively manage the pain. Since a rash could be a sign of a more serious condition, patients using pain relievers should always check their skin for rashes or lesions, and these should be reported to a healthcare provider as soon as possible.

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Hepatitis C

Hepatitis C infection is a recognized trigger for lichen planus. In fact, some experts feel the link between these conditions is so strong that they recommend any patient diagnosed with lichen planus to also be screened for hepatitis C. Hepatitis C is an inflammation of the liver, and the C form of the condition is caused by a virus that can be transmitted through blood. Patients with this form of hepatitis may be asymptomatic for decades, and individuals born between 1945 and 1965 are at five times the risk of this infection compared to the general population. Individuals who received blood transfusions or organ transplants before 1992 are also at an increased risk of the condition, and doctors recommend they receive a blood test to screen for the condition. If symptoms of hepatitis C occur, they generally include jaundice, weight loss, an accumulation of fluid in the abdomen, swelling in the legs, and easy bruising or bleeding. These symptoms are part of an acute phase that normally occurs up to three months after exposure. Antiviral medication is the standard treatment for this form of hepatitis, and many new drugs are currently being researched.

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Exposure To Certain Chemicals

Exposure to certain chemicals is a strong risk factor for lichen planus. Gold, arsenic, iodide compounds, and certain dyes used for medical procedures are some of the many chemical sources linked to this condition, and it occasionally develops as a reaction to metals in dental fillings. Individuals who work with gold, arsenic, or other potentially hazardous chemicals should speak with their employer about the appropriate safety precautions for handling these, and they should wear all required protective gear when working. Anyone who is going to have a medical procedure involving the use of contrast dye should check with their healthcare provider about the risks associated with the dye and whether there may be an alternative contrast available. At the dentist, patients who are told they need a filling or other dental work should ask about options that do not use mercury or metals. Individuals exposed to chemicals should remain vigilant for possible symptoms of lichen planus and report these to their healthcare provider as soon as they are observed.