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The various types of lichen planus treatments include immunosuppressant drugs, antihistamines, corticosteroids and retinoids. The choice of a lichen planus treatment should be made by the diagnosing doctor. Which drug is best depends on the type and severity of lichen planus and the symptoms experienced by the patient. There is not a single lichen planus treatment that cures the disease, and often it can be resolved without any treatment at all.
Lichen planus is thought to be an autoimmune disease, although its exact mechanism is unknown. This means that the body's immune system, normally responsible for fighting foreign bodies such as bacteria in infectious diseases, attacks the body itself. This is why lichen planus treatment may include the use of immunosuppressant drugs. It is not contagious and cannot be passed from person to person.
The disease usually manifests as a red or purplish rash, most commonly beginning on the wrists and legs. It may spread over the entire body. The papules, or bumps, of the rash are flat-topped and may be very itchy. A common characteristic of the papules is the appearance of fine, white lines, referred to as Whickham striae.
Lichen planus less commonly affects the nails and scalp, genitalia and mucous membranes of the mouth, which is referred to as oral lichen planus. It may appear as white, lace-like patterns in these areas. The disease usually resolves on its own but this can take anywhere from six months to five years.
Lichen planus, depending on where it appears, and the characteristics of the rash, can be sub-divided into various descriptive diagnoses such as hypertrophic, atrophic and vesicular lichen planus. The different types of lichen planus treatment are prescribed according to these characteristics. In mild cases of the disease, resolution may occur with no treatment at all. Symptoms, such as itching, may require the use of an antihistamine. Often a sedating antihistamine, such as chlorpheniramine, is useful, to help the patient sleep without scratching.
The most commonly used lichen planus treatment is corticosteroids, either topically or, in more severe cases, systemically. Long-term systemic treatment is discouraged due to the potential long-term side effects of corticosteroids. They work by decreasing the inflammation associated with lichen planus. Retinoids, a synthetic version of vitamin A, such as topical tretinoin or oral isotretinoin, have also been used.
In severe cases, immunosuppressive drugs such as cyclosporine may be prescribed. Due to the autoimmune nature of the disease, suppressing the immune system may improve or resolve it. Light therapy, or PUVA, which is UVA light exposure in combination with psoralen, has shown some benefit in the treatment of lichen planus.
The choice of lichen planus treatment should be made in consultation with a medical practitioner. All the possible treatment options may have side effects, so a risk/benefit assessment will likely be done. Concomitant diseases, chronic drugs and factors such as pregnancy and lactation should be considered before the best option is chosen.
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