Annular Lichen Planus

Dr. Harun Ar Rashid, MD - Arthritis, Bones, Joints Pain, Trauma, and Internal Medicine Specialist Dr. Harun Ar Rashid, MD - Arthritis, Bones, Joints Pain, Trauma, and Internal Medicine Specialist
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Rx Dermatology (A-Z)

Annular lichen planus is a skin condition that can cause discomfort and concern. In this article, we will simplify the complex terminology and provide clear explanations to help you better understand annular lichen planus. We’ll cover its types, causes, symptoms, diagnostic tests, treatments, and medications in plain English.

Types of Annular Lichen Planus:

  1. Classic Annular Lichen Planus: This is the most common type, characterized by round or ring-shaped patches on the skin.
  2. Hypertrophic Annular Lichen Planus: This type results in thicker, raised patches compared to the classic form.
  3. Linear Annular Lichen Planus: Linear patterns of lesions or patches appear on the skin in this variant.
  4. Bullous Annular Lichen Planus: In this rare type, fluid-filled blisters develop within the annular patches.

Causes of Annular Lichen Planus:

  1. Immune System Dysfunction: It’s believed that an overactive immune system may mistakenly attack the skin cells, causing lichen planus.
  2. Genetic Factors: Some individuals may have a genetic predisposition to developing this condition.
  3. Medications: Certain drugs, such as beta-blockers, NSAIDs, and diuretics, can trigger lichen planus in some cases.
  4. Viral Infections: Infections like hepatitis C have been linked to the development of lichen planus.
  5. Allergies: Allergic reactions to chemicals or substances can sometimes lead to this skin condition.
  6. Stress: High stress levels may exacerbate or trigger annular lichen planus in susceptible individuals.
  7. Hormonal Changes: Hormonal imbalances, especially in women, have been associated with lichen planus.
  8. Dental Fillings: Some studies suggest a potential connection between dental amalgam fillings and lichen planus, but more research is needed to confirm this link.
  9. Chronic Illnesses: Conditions like diabetes and hypertension may increase the risk of developing lichen planus.
  10. Autoimmune Diseases: Having an autoimmune disorder may raise the likelihood of lichen planus occurrence.
  11. Inflammatory Conditions: Inflammation in the body can contribute to the development of this skin condition.
  12. Exposure to Chemicals: Contact with certain chemicals, like dyes and perfumes, can sometimes trigger annular lichen planus.
  13. Oral Lichen Planus: Some individuals with lichen planus on their skin may also experience it in the mouth, known as oral lichen planus.
  14. Smoking: Smoking tobacco products may increase the risk of lichen planus, particularly oral lichen planus.
  15. Dental Procedures: Trauma or irritation caused by dental procedures or dental appliances may be a factor.
  16. Infections: Bacterial, fungal, or viral infections can sometimes precede or exacerbate lichen planus.
  17. Sunlight Exposure: Sunburn or excessive sun exposure may trigger or worsen lichen planus in some cases.
  18. Skin Injuries: Previous skin injuries or trauma may lead to the development of annular lichen planus.
  19. Inflammatory Bowel Disease: Individuals with conditions like Crohn’s disease or ulcerative colitis may have a higher risk of lichen planus.
  20. Environmental Factors: Exposure to specific environmental factors may play a role in some cases of lichen planus, though further research is needed.

Symptoms of Annular Lichen Planus:

  1. Skin Lesions: Round or ring-shaped, flat-topped, and itchy patches on the skin.
  2. Reddish or Purple Color: The patches may appear reddish or purple, with white streaks or lines.
  3. Scaling: The affected skin may become scaly, with a rough texture.
  4. Itching and Discomfort: Itchy and sometimes painful sensations in the affected areas.
  5. Nail Changes: Nail abnormalities, such as ridges, grooves, or pitting, can occur.
  6. Mouth Sores: In cases of oral lichen planus, white, lacy patches or sores inside the mouth.
  7. Hair Loss: Temporary hair loss within the affected areas.
  8. Genital Involvement: In some instances, genital areas can be affected, causing discomfort and itching.
  9. Blisters: Bullous lichen planus can lead to fluid-filled blisters within the lesions.
  10. Thickened Skin: Hypertrophic lichen planus results in thickened, raised patches.
  11. Linear Patterns: Linear lichen planus presents with lesions in lines or streaks.
  12. Discoloration: Darkening or hyperpigmentation of the affected skin.
  13. Burning Sensation: Some individuals may experience a burning sensation in the lesions.
  14. Sensitivity to Heat: The affected skin may be more sensitive to heat.
  15. Difficulty Eating: Oral lichen planus can make eating painful and challenging.
  16. Changes in Taste: Altered or reduced sense of taste in oral lichen planus.
  17. Ulceration: Severe cases may lead to ulceration in oral lichen planus.
  18. Dry Mouth: Reduced saliva production can occur in oral lichen planus.
  19. Swelling: Swelling of the affected areas, especially in bullous lichen planus.
  20. Psychological Distress: Anxiety and stress due to the appearance and discomfort of the lesions.

Diagnostic Tests for Annular Lichen Planus:

  1. Physical Examination: A dermatologist will examine your skin and may inquire about your medical history.
  2. Skin Biopsy: A small sample of affected skin is taken for examination under a microscope to confirm the diagnosis.
  3. Patch Testing: To identify potential allergens or irritants that may contribute to lichen planus.
  4. Blood Tests: To check for underlying conditions or infections associated with lichen planus.
  5. Dermoscopy: Using a special magnifying tool to examine skin lesions in more detail.
  6. Scraping Test: Scraping off the top layer of skin to examine it under a microscope.
  7. Tzanck Smear: A test to examine cells from the base of a blister.
  8. Allergy Testing: To determine if any allergies are triggering lichen planus.
  9. Direct Immunofluorescence: A laboratory test to detect specific antibodies in the skin.
  10. Cultures: To rule out bacterial or fungal infections that may mimic lichen planus.
  11. Skin Imaging: Imaging techniques like ultrasound may be used to assess deeper skin layers.
  12. Oral Examination: For oral lichen planus, a dentist or oral specialist will examine the mouth and may perform a biopsy.
  13. Biopsy of Nail Tissue: In cases of nail involvement, a nail biopsy may be necessary.
  14. Endoscopy: If gastrointestinal involvement is suspected, an endoscopy may be performed.
  15. Phototesting: To assess photosensitivity in certain cases.
  16. Allergen Patch Testing: To identify potential allergens contributing to lichen planus.
  17. Immunological Tests: To check for autoimmune markers in the blood.
  18. Viral Testing: To investigate viral infections like hepatitis C.
  19. Skin Culture: To rule out bacterial or fungal infections.
  20. Histopathology: Microscopic examination of skin tissue for characteristic changes.

Treatments for Annular Lichen Planus:

  1. Topical Corticosteroids: These are creams or ointments that reduce inflammation and itching on the skin.
  2. Oral Corticosteroids: In severe cases, oral steroids may be prescribed to control inflammation.
  3. Topical Calcineurin Inhibitors: These non-steroidal creams can help manage lichen planus, especially in sensitive areas.
  4. Antihistamines: Over-the-counter or prescription antihistamines can alleviate itching.
  5. Phototherapy: Exposure to UVB or PUVA light can help improve skin lesions.
  6. Immune Modulators: Medications like methotrexate or cyclosporine may be used in severe cases.
  7. Retinoids: Oral or topical retinoids can be prescribed to reduce inflammation.
  8. Topical Anesthetics: For pain relief in oral lichen planus.
  9. Saliva Substitutes: To manage dry mouth in oral lichen planus.
  10. Dental Treatments: Addressing dental issues or irritants that exacerbate oral lichen planus.
  11. Cryotherapy: Freezing therapy to remove individual lesions.
  12. Laser Therapy: Laser treatment can help reduce the appearance of skin lesions.
  13. Moisturizers: Emollients can soothe and hydrate the skin.
  14. Avoiding Triggers: Identifying and avoiding triggers, such as specific medications or allergens.
  15. Stress Management: Techniques like meditation or yoga can help manage stress-related flares.
  16. Lifestyle Changes: Maintaining good oral hygiene for oral lichen planus.
  17. Wound Care: Proper wound care for open sores or ulcers.
  18. Nutritional Support: A balanced diet with vitamin and mineral supplementation, if necessary.
  19. Psychological Support: Counseling or support groups for managing emotional distress.
  20. Regular Follow-up: Consistent monitoring by a healthcare professional to track progress.

Medications for Annular Lichen Planus:

  1. Clobetasol (Topical Corticosteroid): Reduces skin inflammation and itching.
  2. Prednisone (Oral Corticosteroid): Controls severe inflammation when necessary.
  3. Tacrolimus (Topical Calcineurin Inhibitor): Suppresses the immune response in affected skin.
  4. Hydroxychloroquine (Immune Modulator): Modifies the immune system’s response.
  5. Methotrexate (Immune Modulator): Used for severe cases.
  6. Acitretin (Retinoid): Helps reduce skin inflammation.
  7. Diphenhydramine (Antihistamine): Relieves itching.
  8. Lidocaine (Topical Anesthetic): Provides local pain relief.
  9. Fluocinonide (Topical Corticosteroid): Reduces inflammation and itching.
  10. Dexamethasone (Oral Corticosteroid): Controls severe inflammation.
  11. Mycophenolate Mofetil (Immune Modulator): Suppresses immune system activity.
  12. Topical Tretinoin (Retinoid): Aids in skin healing.
  13. Cyclosporine (Immune Modulator): Used for severe cases.
  14. Apremilast (PDE4 Inhibitor): Helps reduce inflammation in oral lichen planus.
  15. Pimecrolimus (Topical Calcineurin Inhibitor): Suppresses immune response on the skin.
  16. Nystatin (Antifungal): Treats fungal infections that may accompany lichen planus.
  17. Ranitidine (H2 Blocker): May be used to relieve symptoms in some cases.
  18. Chlorhexidine Mouthwash: Helps maintain oral hygiene in oral lichen planus.
  19. Vitamin A Supplements: Can support skin health.
  20. Lidocaine Gel (Topical Anesthetic): Provides relief from oral discomfort.

In conclusion, annular lichen planus is a skin condition with various types, potential causes, a range of symptoms, diagnostic tests to confirm the diagnosis, and multiple treatment options. It’s important to consult a healthcare professional for proper evaluation and management of annular lichen planus, as individual cases can vary widely. By understanding the condition and its treatment options, you can work with your healthcare provider to find the best approach for your specific situation, improving your overall quality of life.

 

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. Thank you for giving your valuable time to read the article.

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References

 

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