What are these dark patches on this man's forehead and cheek?
This 19 year old male came into our office with a complaint of a dark patch on his forehead and right cheek. He stated that the lesions were present for five months and were not painful or itching. He stated that he had not started any new medications or products. What is this condition?
Lichen Planus
What It Is?
Lichen planus is an inflammatory disease that usually affects the skin, the mouth, nails and hair. The cause of lichen planus is unknown. However, some believe that it is an autoimmune response to a medication or a virus. It is often times, associated with Hepatitis C but not always. Lichen planus affects men and women equally, and occurs most often in middle-aged adults, but can be seen in any age group. Lichen planus is not an infectious disease. It is impossible to give lichen to someone else.
Lichen Planus of the Skin
Lichen planus of the skin can look like reddish-purple, flat bumps or patches that may be very itchy. They can be anywhere on the body, but are more common on the inside of the wrists and ankles. The disease can also occur on the lower back, neck, legs, genitals, and in rare cases, the scalp and nails. Often times, a skin biopsy may be needed to confirm the diagnosis. This was done for the patient above.
In some cases, lichen planus of the skin causes few problems and needs no treatment. However, in many cases there is severe itching. Lichen planus may resolve on its own, but takes time. As it heals, lichen planus often leaves a dark brown discoloration on the skin. Like the bumps themselves, these stains may eventually fade with time without treatment.
Nail/Hair Involvement
Nail changes can occur with lichen planus as well. Nail changes associated with lichen planus include longitudinal ridging and grooving, splitting, nail thinning and nail loss. In severe cases, the nail may be temporarily or permanently destroyed. Hair involvement is rare, but can lead to irritation, redness and permanent hair loss if treatment is not started early.
Treatment
There is no known cure for lichen planus, but treatment can be used to relieve itching and improve the appearance of the rash until it goes away. The two most common treatments include the use of topical corticosteroid creams and oral antihistamines. Both work to reduce itching. More severe cases of lichen planus may require stronger medications such as oral steroids and ultraviolet light treatment called Narrowband UVB, which we offer at Florida Skin Center.
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