How Common is Lichen Planus Erosive Form?

The exact number of people who have the erosive form of lichen planus is not known.

What else can Lichen Planus Erosive Form be?

Crohn's disease, autoimmune bullous diseases, Behcet syndrome, erythema multiforme, Stevens-Johnson syndrome, lichen sclerosus, plasma cell vulvitis, vulvar intraepithelial neoplasm, atrophic vaginitis, oral yeast infection (oropharyngeal candidiasis), leukoplakia, squamous cell carcinoma, leukoedema, and allergic contact mucositis.

What kinds of test are needed for Lichen Planus Erosive Form?

The types of tests that may be needed for Lichen Planus Erosive Form include: 1. Biopsy: A small sample of the affected area may be taken to check for cancer or to confirm the diagnosis. 2. Examination of the skin and linings of the mouth and other body parts: The doctor will check all areas of the skin and the linings of the mouth and other body parts, as Lichen Planus Erosive Form can often show up in multiple places. 3. Testing for Hepatitis C: A test for Hepatitis C may be suggested, as there could be a link between this condition and Lichen Planus Erosive Form.

How is Lichen Planus Erosive Form treated?

The erosive form of Lichen Planus is typically treated with topical corticosteroids, which are medications applied directly to the affected area. For oral erosive Lichen Planus, high or ultra-high potency corticosteroids should be applied 3 to 4 times a day. For genital erosions, corticosteroids in the form of ointment or cream should be applied daily. In cases where topical corticosteroids are not effective or in severe cases, other treatments such as topical calcineurin inhibitors or oral medications like prednisone, methotrexate, mycophenolate, minocycline, cyclosporine, hydroxychloroquine, or acitretin may be prescribed. Topical anesthetics like viscous lidocaine can also be used to manage pain associated with erosive Lichen Planus.

What are the side effects when treating Lichen Planus Erosive Form?

When treating Lichen Planus Erosive Form, there can be potential side effects such as: - Additional infections, including candidiasis, cellulitis, and herpes simplex - The possibility of transformation into squamous cell carcinoma - Scarring, which can interfere with intercourse, urination, and eating

Are there long term effects of Lichen Planus Erosive Form?

The prognosis for Erosive Lichen Planus (ELP) is generally poor, as it is a chronic condition that tends to persist for years and often does not respond well to treatment. Recurrences are common, even with consistent treatment over an extended period. Complications from ELP can include further infections, the development of squamous cell carcinoma, and lasting scarring.

What type of doctor should I see for Lichen Planus Erosive Form?

Dermatologist ,gynecologists, and other health care providers

Lichen Planus Erosive Form

What is Lichen Planus Erosive Form?

Erosive lichen planus (ELP) is a type of lichen planus, causing long-lasting, painful sores on the skin and inside the mouth or genitals. In this condition, the immune system mistakenly attacks the outer layer of your skin or mucus membranes, carried out by a type of white blood cell called CD8 T lymphocytes. Sometimes, ELP can appear alongside other forms of lichen planus, or it could be triggered by exposure to certain medications. Common symptoms are painful, lingering sores primarily in the mouth and genital area. Complications from ELP can include further infections, the development of a type of skin cancer known as squamous cell carcinoma, and lasting scarring.

What Causes Lichen Planus Erosive Form?

Lichen planus (LP) is believed to be a type of autoimmune inflammatory disorder. It is a condition where cells from your immune system, called T-cells, attack the cells found at the base of your skin or the lining of your mouth.

These attacks are typically carried out by specific immune cells called CD8 T cells. Doctors believe these cells are triggered by substances like certain viruses, metals, or drugs that enter the body. This activation leads to the destruction of keratinocytes, which are cells that form a barrier against environmental damage such as bacteria, viruses, and harmful substances.

Additionally, lichen planus has been linked to other autoimmune diseases. These include vitiligo (a condition that causes loss of skin color), autoimmune thyroid disease (conditions where the immune system mistakenly attacks the thyroid), and alopecia areata (a condition that causes hair to fall out in small patches).

Moreover, lichen planus has been associated with Hepatitis C virus (HCV). Although there is no established link between HCV and a severe form of lichen planus called erosive LP. In a study, patients with lichen planus were up to 5.4 times likely to be positive for HCV. However, this link wasn’t significantly notable in all geographical groups according to further analysis.

Like other forms of lichen planus, erosive LP can be caused by certain drugs and often improves when the problematic drug is stopped.

Risk Factors and Frequency for Lichen Planus Erosive Form

Lichen planus (LP) is a condition affecting between 0.5% and 2% of people globally. The most common type is oral LP. It generally starts in middle age, around 50 to 60 years old and it’s rare in children. Skin LP seems to affect men and women equally, while oral LP occurs three times more often in women.

Erosive lichen planus is a specific type of lichen planus. The exact number of people who have this condition isn’t known. It usually begins between the ages of 50 and 80, with women twice as likely to get it as men. This condition commonly appears as painful ulcers in the mouth or on the genital skin. It’s possible to have ulcers in multiple places. In one study, 57% of patients with oral LP also had vulvar LP. Another study found that 17.6% of patients with vulvar LP had the erosive type.

Signs and Symptoms of Lichen Planus Erosive Form

Erosive lichen planus (ELP) is a health condition that typically affects the lining of the mouth or genitals. However, it can sometimes extend to other areas like the eyelids, throat, anus, bladder, or the external part of the ear. Patients usually develop painful, red sores and ulcers that can last for several months.

In women, ELP can affect the vulva and vagina leading to symptoms such as:

Pain
Pain during urination
A burning sensation
Pain during sexual intercourse
Bleeding after sexual intercourse
Blood-tinged vaginal discharge

The sores in these areas appear red with shiny surfaces and well-defined edges. They often have tiny white lines around the edge, known as Wickham striae. These sores tend to mirror each other on both sides and take time to heal with frequent recurrences. If not treated, it may lead to permanent changes like scarring, loss of the inner folds of the vulva, and narrowing of the vagina.

In oral ELP, sores can occur on various parts of the mouth, including the inner cheeks, lips, tongue, or the red part of the lips. These sores are also generally mirrored on both sides. Severe pain from these ulcers can lead to:

Loss of appetite
Weight loss
Nutritional deficiencies
Depression

Light touch, like brushing the teeth, can cause the mouth lining to bleed. Sores can also form on areas that have been lightly touched, a phenomenon known as the Koebner phenomenon. Compared to common mouth ulcers, sores from ELP are typically larger, irregularly shaped, and take several weeks to heal. Extensive sores can also develop on the gums due to ELP. Once the sores have healed, scarring and skin discoloration are typical.

There is a specific type of ELP known as the Vulvovaginal-gingival (VVG) syndrome, which affects the vulva, vagina, vestibule (entrance of the vagina), and mouth. Other areas such as the skin and throat might also be affected. Usually, sores in these different areas do not occur at the same time and are often very resistant to treatment.

Testing for Lichen Planus Erosive Form

Doctors usually diagnose erosive lichen planus based on your symptoms and how your skin looks. If they’re not sure, they might take a small sample of the affected area (known as a biopsy) to check for cancer or to confirm the diagnosis. This condition might look different under a microscope if the skin has open sores (known as ulcers).

If your doctor thinks you might have lichen planus, they’ll check all your skin and the linings of your mouth and other body parts, because this condition often shows up in more than one place. They’ll ask about symptoms in your food pipe (esophagus), eyes (conjunctiva), urine passage (urethra), back passage (anus), or voice box (larynx), because these could mean the lining of these areas is affected as well. If erosive lichen planus isn’t diagnosed and treated, it can cause scarring and can stop these areas from working properly.

Your doctor may also suggest a test to check for Hepatitis C, as this could be linked to your condition.

Treatment Options for Lichen Planus Erosive Form

Treating erosive lichen planus can be challenging for patients and doctors equally. This is because the course of treatment tends not always to be effective, and patients often experience a return of the disease. One of the main treatments for both oral and genital erosive lichen planus is a type of medication called topical corticosteroids.

Topical corticosteroids are types of medications that are usually applied directly to the area affected by the disease. The usual course of application lasts from 4 to 6 weeks, but often, patients might need to continue using it for the long term. For genital erosions, corticosteroids in the form of ointment or cream should be applied daily. Once the patient shows sign of recovery, the frequency of application can be gradually reduced. This will help to prevent the disease from coming back, while also reducing the risk of side effects. For oral erosive lichen planus, corticosteroids of high or ultra-high potency are recommended and should be applied 3 to 4 times a day.

For treating disease along the gum line (gingival disease), patients can either rinse with oral elixirs or use a gingival tray. When topical corticosteroids do not work or in severe cases, other treatments like topical calcineurin inhibitors (tacrolimus and pimecrolimus) can be prescribed. In cases where the disease is too severe or resistant to other treatments, then a doctor might prescribe drugs like oral prednisone, or more severe options such as methotrexate, mycophenolate, minocycline, cyclosporine, hydroxychloroquine or acitretin.

Erosive lichen planus can often come with pain. Topical anesthetics like viscous lidocaine can be used to help manage this pain. For erosive lichen planus of the vulva and vagina, dilators and surgery might be beneficial to correct anatomical distortions caused by the disease, such as adhesions and scarring.

Erosive lichen planus is a skin condition that can appear on different parts of the body, and its diagnosis might be confused with other conditions depending on where it shows up. Doctors consider several diseases that could have similar symptoms:

Crohn’s disease can cause erosions or sores in the mouth, vulva, perineum, or anus, sometimes appearing years before any signs in the bowels.
Autoimmune bullous diseases can look very similar to erosive LP and are usually differentiated using special skin tests.
Behcet syndrome, erythema multiforme, and Stevens-Johnson syndrome can all appear in ways that closely resemble erosive LP.
If erosive LP affects the female genitalia, it can be mistaken for a condition called lichen sclerosus, but lichen sclerosus rarely affects the vagina or oral mucosa.
Other conditions of the genitalia that are considered include plasma cell vulvitis, vulvar intraepithelial neoplasm, and atrophic vaginitis.
When erosive LP occurs in the mouth, doctors consider conditions such as oral yeast infection (oropharyngeal candidiasis), leukoplakia, squamous cell carcinoma, leukoedema, and allergic contact mucositis.

It’s crucial that healthcare providers run various tests to distinguish between these conditions and diagnose the right one.

What to expect with Lichen Planus Erosive Form

Erosive lichen planus is a skin condition characterized by long-lasting and often stubborn lesions that generally don’t respond well to treatment. The disease tends to persist for years, and recurrences are common, even when consistently using treatment over an extended period.

Possible Complications When Diagnosed with Lichen Planus Erosive Form

People with a condition called erosive lichen planus are at high risk for getting additional infections. This occurs particularly with yeast infections (candidiasis), skin infections caused by a bacteria called staphylococcus aureus (cellulitis), and with herpes simplex, a virus that can cause sores. Oral lichen planus, which affects the mouth, has been linked to an approximately 1% chance of turning into a type of skin cancer called squamous cell carcinoma. The cause is believed to be long-lasting inflammation of the mucus membranes in the mouth.

Lichen planus affecting the penis and vulva also carries a risk of developing into squamous cell carcinoma, although we don’t know the exact rates. Patients often experience scarring as a result of erosive lichen planus, which can cause problems with sexual intercourse, urinating, and eating.

Common complications of erosive lichen planus are:

Additional infections, such as candidiasis, cellulitis, and herpes simplex
Potential transformation to squamous cell carcinoma
Scarring, which can interfere with intercourse, urination, and eating

Preventing Lichen Planus Erosive Form

Patients should be informed about the progression and possible complications of a skin condition known as erosive lichen planus. It’s important for them to quit smoking and get vaccinated against HPV (Human Papillomavirus) as these steps can help lower the chances of this condition developing into a type of skin cancer called squamous cell carcinoma.