Lichen planus and its variants

Lichen planus can present in several different forms, including classic skin lichen planus (itchy, flat-topped purple bumps), oral lichen planus affecting the mouth, nail lichen planus, lichen planopilaris affecting the scalp, and less common variants affecting other areas like the genitals or causing blistering. Each variant has its own typical appearance and management considerations.

All variants share an underlying autoimmune mechanism where the immune system attacks the skin or mucous membranes, though the exact trigger for this reaction usually isn't identified. Occasionally, certain medications, hepatitis C infection, or dental materials have been linked to triggering lichen planus in susceptible individuals.

Symptoms vary by location: skin lichen planus causes itchy purple bumps, oral lichen planus causes white patches or painful sores in the mouth, and nail or scalp variants cause specific changes to those structures. Some people experience more than one variant simultaneously.

Most variants are not dangerous but can be persistent and uncomfortable, and certain forms, particularly some oral lichen planus presentations, carry a small increased risk of oral cancer and need regular monitoring. Scarring variants like lichen planopilaris can cause permanent changes if untreated.

There's no strong evidence of direct inheritance, though a general predisposition to autoimmune conditions can run in families. Most cases occur without a specific family history of lichen planus itself.

Most variants resolve on their own over months to a couple of years, though some, particularly scarring forms affecting the scalp or severe oral disease, can be more persistent and need ongoing management. Treatment aims to control symptoms and prevent complications while the condition runs its course.

Treatment is tailored to the specific variant and location, typically involving topical or oral corticosteroids, other immune-modulating treatments, and regular monitoring, particularly for oral variants given the small cancer risk. Your dermatologist will individualise the approach based on which variant you have.

Skin lichen planus often resolves within one to two years, while oral and scalp variants can be more chronic and persistent, sometimes requiring longer-term management. The specific course varies significantly between individuals and variants.

Oral lichen planus specifically affects the mouth lining, causing white patches or painful sores, and carries a small increased risk of oral cancer requiring regular monitoring, while skin lichen planus causes itchy purple bumps on the skin and doesn't carry this specific cancer risk. Both share the same underlying autoimmune process but need different monitoring approaches.

Persistent skin, nail, mouth or scalp changes suggestive of lichen planus should be assessed by a dermatologist. Private dermatology consultations can typically be arranged within about two weeks, considerably faster than standard NHS waiting times.