If you notice a red or purplish rash that itches and spreads to several areas of your skin and mucous membranes, it might be a condition known as lichen planus. Lichen planus is a common inflammatory condition that can cause purple, itchy, flat bumps on the skin and lacy white patches on the mouth and genital mucosa, sometimes with painful sores.
The exact cause of this condition is not fully understood, but it seems to involve an immune response where the immune system reacts in a way that affects skin or mucous membrane cells.
A functional and integrative medicine approach to lichen planus may help uncover contributing factors and address them using diet, lifestyle, and supplementation. This can complement conventional treatment to support overall well-being and quality of life.
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What is Lichen Planus?
Lichen planus can cause purplish-raised bumps on the skin and mucous membranes. It is most common on the skin around the wrists and elbows (flexor surfaces), the back of the hands (dorsal surfaces), and the fronts of the lower legs. About half of those who have skin lesions may also develop lichen planus in the mouth. These skin lesions are not contagious.
The rash of lichen planus is typically characterized by the six Ps: pruritic (itchy), polygonal (the rash shape has many sharp angles), planar (has a flat top), purple papules (bumps), and plaques (raised, discolored, patches). Since lichen planus causes firm, raised, discolored bumps on the skin, it is characterized as a lichenoid dermatosis.
As inflammation develops in the skin due to the body’s immune system reacting to cells in the skin and mucous membrane, a rash that appears purple, itchy, and flat bumps can develop over several weeks.
While this condition can impact anyone, it is most common in middle-aged adults between the ages of 30 and 60 years old, with oral lesions more common in women than men. Overall, it affects around 0.22% to 1% of the adult population, with oral lichen planus impacting 1% to 4% of people worldwide.
Lichen Planus Signs & Symptoms
Lichen planus can cause symptoms that impact the skin, nails, and mucous membranes.
On the skin, lichen planus can present with:
- Red, purple, or bluish-shiny, flat bumps
- Papules that are tiny, usually about the size of the tip of a pin (0.4 millimeters) up to the width of a pencil (1 centimeter)
- When the skin is scratched, the rash may develop along the lines of scratching
- Itchiness
- Hair loss in rare cases
- Darkening of the skin after lesions heal
When lichen planus affects the mucous membranes, it can cause symptoms such as:
- Lacy white patches on the tongue or inside of the cheeks
- Painful sores in the mouth that can make it difficult to eat
- Painful sores on the genitals
- Scarring
Lichen planus can also impact the nails in around 10% of those affected, where it can cause symptoms like:
- Nail scarring
- Nail cracking, splitting, and/or loss
- Dark lines from the tip of the nail to the base of the nail
Lichen Planus Possible Causes
The causes of lichen planus are still being researched, but the condition seems to involve an immune response affecting cells in the skin and mucous membranes that leads to inflammation and the resulting rash and other symptoms. In people with lichen planus, T cells of the immune system that normally help protect your body from infection may react to a protein in the skin and mucous membranes.
The immune response that occurs in lichen planus may be triggered by factors like an allergic reaction to the metal in dental fillings, infection with the hepatitis C virus, taking pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs), physical and emotional stress, or vaccines. For example, systemic viral infections such as hepatitis C seem to modify antigens on the surface of skin cells (keratinocytes) that may trigger the immune response to react to them.
Other research shows an association between Candida infection and oral lichen planus and changes in the oral microbiome in patients with lichen planus. Patients with oral lichen planus had more abundant populations of Campylobacter rectus, Fusobacterium nucleatum, and Neisseria mucosa in their oral microbiomes.
Studies also suggest that oral lichen planus may be associated with vitamin D deficiency.
One rare type of lichen planus, known as familial bullous lichen planus, can run in families.
Functional Medicine Labs to Test for Root Cause of Lichen Planus
Functional medicine testing can help identify factors that may contribute to lichen planus so that they can be addressed as part of an integrated approach to support overall health.
Hepatitis C Virus
Since lichen planus is sometimes associated with hepatitis C infection of the liver, testing for the virus can be done. Antibodies to the hepatitis C virus can be measured in the blood to help identify hepatitis C infection.
Vitamin D Levels
Since vitamin D deficiency is associated with oral lichen planus and dysregulation of the immune system overall, vitamin D levels can be measured in the blood to determine if supplementation may be needed to support healthy levels.
Folate Levels
Folate (vitamin B9) plays important roles in DNA and amino acid metabolism. Research suggests that patients with lichen planus may have decreased levels of folate in their blood. Levels of folate can be evaluated by this test, offered by Access Med Labs.
Candida Testing
Since increased levels of oral Candida have been associated with oral lichen planus, blood and urine testing can provide a comprehensive picture of candida overgrowth in the body. For example, the Candida Profile from Alletess Medical Laboratory measures IgA, IgG, and IgM reactivity to Candida to help determine if this fungus is causing an immune reaction. Urine testing like the Candida Panel from RealTime Laboratories can be done at home to detect Candida DNA that can signal invasive fungal presence.
Additional Lab Tests
A skin biopsy may be used to take a small piece of affected tissue and examine it under the microscope to see if the cells show typical changes involved in lichen planus.
Conventional Treatment for Lichen Planus
Depending on the level of discomfort, location, and extent of lichen planus, various options may be considered. On the skin, uncomplicated lichen planus often clears up on its own in a few months to years. If the skin rash is causing discomfort or fails to resolve, a topical corticosteroid cream or ointment may be used to help ease discomfort and support skin health. In more severe or widespread cases, corticosteroids may be given orally or by injection.
In other cases, the oral antimalarial medication hydroxychloroquine (Plaquenil), retinoids, and oral antibiotics like metronidazole (Flagyl) may be used. Antihistamines are sometimes also added to address the itching associated with lichen planus.
When lichen planus is more severe, medications are used to alter the immune response, such as cyclosporine (Sandimmune), azathioprine (Azasan), methotrexate (Trexall), mycophenolate (Cellcept), sulfasalazine or thalidomide (Thalomid).
In other cases, phototherapy can help manage lichen planus. This treatment involves exposing the affected skin to ultraviolet B light two to three times a week for several weeks.
Functional Medicine Treatment for Lichen Planus
Since these conventional approaches are not always effective and/or may cause undesirable side effects, a functional medicine approach can be integrated into care to help address the underlying contributing factors and support overall well-being.
An anti-inflammatory diet, targeted supplementation, and integrative therapies such as mind-body practices and oatmeal baths can help soothe the skin and support the immune system to manage lichen planus.
Nutrition Considerations for Lichen Planus
Nutrition plays a key role in the development of the dysregulation of the immune system that occurs in inflammatory skin conditions like lichen planus. A personalized anti-inflammatory diet can help support the body's natural defenses against inflammation that contributes to the skin lesions of lichen planus. One way of eating to support a balanced immune response is the Mediterranean Diet which emphasizes whole fresh vegetables and fruits while limiting processed foods and additives, caffeine, and alcohol to support overall health.
In particular, vitamin A-rich foods like carrots, sweet potatoes, kale, and winter squashes support the immune system and may help maintain skin and mucous membranes. Conventional treatment approaches to lichen planus may include the use of retinoid-based drugs that are derived from vitamin A to help relieve many of the symptoms.
If a person is found to be deficient in folate with laboratory testing, folate-rich foods can be increased in the diet. These include beef liver, asparagus, beets, avocados, and legumes like garbanzo beans, pinto beans, and lentils.
If Candida overgrowth has been detected in patients with oral lichen planus, it can be helpful to focus on low-sugar fruits, non-starchy vegetables, non-glutinous grains, some fermented foods, and dairy products.
To avoid further irritation and discomfort with oral lichen planus, it can help to avoid spicy or acidic foods or drinks such as hot peppers, citrus fruits, tomatoes, and alcohol.
Supplements & Herbs for Lichen Planus
Herbal and other supplements may help support the immune system and soothe skin in lichen planus. Supplementation can help replenish deficiencies of vitamin D. While topical treatment with aloe vera gel or turmeric may help support skin health.
Vitamin D
Vitamin D plays a crucial role in supporting the immune system, including impacting the function of T cells. If insufficient levels are found on testing, vitamin D supplementation may help to replenish levels and support the immune response. Studies show significant improvement in symptoms of lichen planus with vitamin D supplementation as an adjuvant to conventional steroid therapy and/or placebo.
Aloe vera
Some studies suggest that aloe vera gel may help support the management of lichen planus of the vulva and mouth. For example, a randomized, double-blind clinical trial of 40 patients with oral lichen planus showed that aloe vera gel was more effective than a topical synthetic corticosteroid (triamcinolone acetonide) for reducing symptoms over eight weeks of treatment.
Similarly, aloe vera mouthwash seems to help support oral health when lichen planus impacts the mouth.
Turmeric
Curcumin, which is derived from turmeric, has antioxidant, anti-inflammatory, antimutagenic, antimicrobial, and anticancer properties. Turmeric ointment seems to support the management of inflammation and modulate the immune system to improve the appearance and comfort of oral lichen planus.
Complementary and Integrative Medicine for Lichen Planus
In addition to diet and supplementation, integrative approaches may help support the management of symptoms of lichen planus.
Oatmeal
Oatmeal can be soothing to the skin lesions that occur in lichen planus. You can apply oatmeal to the skin by grinding oatmeal into a powder and adding it to a bath to soak your skin or making a sticky paste with ground oats and water that is applied to the skin for about ten minutes.
Stress management
Lichen planus can flare up and get worse with stress, so finding a stress management practice that works for you can help manage symptoms. Mind-body practices like yoga, breath work, meditation, and tai chi activate the body's relaxation response to inhibit the body’s stress response and bring a greater sense of relaxation.
Homeopathy
Homeopathy is a complementary healing modality that uses infinitesimal small quantities of substances to support health. Homeopathic therapies are individualized, taking into account many factors about an individual, such as personality, pathology, and lifestyle preferences. Therefore, remedies need to be matched to the individual by a qualified practitioner.
A randomized controlled trial showed that the homeopathic medicine Ignatia amara 30c reduced lesion size and discomfort in patients with histopathologically-confirmed oral lichen planus over four months of treatment. Small case studies have also shown that homeopathic Aurum metallicum, Lycopodium, and Carcinosinum may support the management of lichen planus symptoms.
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Summary
Lichen planus is a common chronic inflammatory condition that results from dysregulation of the immune system. This inflammation can cause red, purple, or bluish-shiny, flat bumps on the skin, lacy white patches on the tongue or inside of the cheeks, painful sores on the genitals, and/or nail changes.
It can be triggered by various factors such as infection with hepatitis C, stress, exposure to certain metals or chemicals, a deficiency of vitamin D, and medications like NSAIDs.
A functional and integrative medicine approach to lichen planus may help uncover contributing factors with testing to look at infections with hepatitis C or Candida and measure vitamin D and folate levels. Identified factors are then addressed using diet, lifestyle, and supplementation. Topical treatments like aloe vera gel, turmeric, and oatmeal may help soothe and support skin health. Mind-body practices to manage stress, like yoga and meditation, are also helpful in supporting skin health and improving quality of life.
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