George Woodbury MD 3/9/2023
As a Memphis Dermatologist, with Rheumatology and Dermatology, I have worked with many patients over the last 30 years with Lichen Planus. So let’s look at some of the key features of this aggravating skin condition:
First, what is Lichen Planus?
Lichen Planus is a term used by Dermatologists for a skin rash which can develop in either children or adults on the arms, legs, and especially in the mouth. The cause is unknown, but we do have generally effective treatment options. The condition is not contagious, it occurs worldwide, and there is much research into discovering more about this condition.
What does Lichen Planus look like, and what sort of Dermatology symptoms tend to occur?
Lichen Planus tends to start as itchy raised bumps – in a characteristic distribution on the body – in the mouth or on the arms and legs. The bumps tend to appear in a burgundy purple or red color – and each of the bumps tends to have a geometric outline – meaning that they occur in the shape of a polygon, like a four- to six-sided geometric figure. A Dermatologist like myself can at times make the diagnosis of Lichen Planus simply by examining the lesions or lesions – by the appearance of the lesions.
Another clue can be the distribution on the body – because development of lesions within the sides of the mouth is characteristic of Lichen Planus. But I have had many Lichen Planus patients without mouth lesions, in my over thirty years as a Memphis Dermatologist.
Can Lichen Planus be similar to other types of Skin Rashes?
Certain common skin rashes – like Psoriasis or Atopic Dermatitis (Eczema) - can have a similar appearance to Lichen Planus – so sometimes it takes a Dermatologist like myself to distinguish which type of reaction is going on in the skin.
What are most common medication trigger factors for Lichen Planus?
High on the list are certain medications and drugs – including Aspirin, just about any Nonsteroidal Drug (NSAIDs), and what are called Angiotensin Converting Enzyme Inhibitors, including Enalapril and Lisinopril. But many different types of medications have been reported as triggering Lichen Planus.
What type of testing can help patients with Lichen Planus?
Dermatologists such as myself generally consider one of about three types of tests to evaluate Lichen Planus. First, we sometimes do a skin biopsy or skin excision to look for whether a given case is actually Lichen Planus or rather a type of Contact Dermatitis, or whether it may be another type of skin condition, such as Dermatitis Herpetiformis (which is due to a sensitivity to wheat gluten), or even possibly an autoimmune condition such as Dermatomyositis. We sometimes do a special type of biopsy called an “Immunofluorescence” to look for what are called antibodies being deposited into the skin, a finding that can be a clue to au autoimmune condition such as Lupus. So sometimes getting the help of a Dermatopathology Laboratory is quite useful in sorting out the underlying condition.
Secondly, sometimes Dermatologists do a scraping for a Fungal Culture test or a KOH test to evaluate whether a yeast of fungal organism is involved - causing a true skin infection. The results of a Fungal culture take a full month, so we sometimes start treatment before we have this test result back from the laboratory. The results of a KOH test take only a few minutes.
Thirdly, a third type of testing – Allergy Patch Testing – can be quite helpful in evaluating for trigger factors of Urticaria or Hives. In my Memphis Dermatology practice, at Rheumatology and Dermatology, I have been offering Allergy Patch Testing since 2004. I am also a member of the American Contact Dermatitis Society, an 1100-Dermatologist organization focused on this type of testing that meets as a society at least once a year to discuss updates on the panels of chemicals to which we offer testing. For instance, the 2023 yearly meeting, of which I was an attendee, was over in New Orleans, Louisiana, attended by over 100 Dermatologists from all over the world, a meeting focusing upon Urticaria and Contact Dermatitis. For more on Allergy Patch Testing, see the page on Allergy Patch Testing on this same web site: https://www.Rheumderm.com.
What treatment options tend to be helpful for patients with Lichen Planus?
Dermatologists often consider either oral steroid tablets (called prednisone or methylprednisolone tablets) or a steroid shot (called a Medrol Shot) for patients with severe reactions. We also commonly consider one of about sixty “topical steroid creams or ointments,” meaning prescription medicines for use “on top of” or “superimposed upon” the skin. These include Clobetasol, Halobetasol, Diflorasone diacetate, and Betamethasone dipropionate cream. These topical steroids are available as creams, ointments, foams, sprays, gels, and many other types of preparations, depending upon what type of substance the medicine is put into – what type of “vehicle” is involved. So Dermatologists such as myself work to develop a ‘care plan’ that uses the most appropriate prescription product to match the condition that our patients are suffering from.
Can the office recommend any cosmetics or toiletry products if I am found to have reactions to certain chemicals?
In addition to being a Cordova Dermatologist, I am the President of Big River Silk™ Skincare, focused on skincare products with lower risk of allergies for people of all ages, from babies to seniors, using a minimal number of chemicals, to minimize the risk of allergic reactions. We offer HypoShea Moisturizer Cream, free of fragrances, dyes, and propylene glycol, as well as HypoShea Oil, convenient for use after bathing or showering (1 oz: $7.97/2 oz: $12.95), and also a new preparation as of 2022: HypoShea Moisturizer Lotion, which is less moisturizing and also fragrance-free. All Big River Silk Skincare products are available in 1 oz: $12.95/2 oz: $18.95/4 oz: $29.95/8 oz: $39.95, on-site at our international headquarters at 8143 Walnut Grove Road, Cordova TN 38018 (1-901-753-0168). Of products can also be ordered at https://www.Bigriversilkskincare.com ($5.00 shipping and handling for orders under $40.00, otherwise free shipping and handling ($10.00 for Canadian orders under $75.00).
All products are available at www.Bigriversilkskincare.com, or at our international headquarters, at 8143 Walnut Grove Road, Cordova, TN 38018, Monday-Friday, from 7:30 AM to 4:30 PM. Or you can call us at 1-901-753-0168. We do offer free shipping and handling or US orders above $40.00 ($70.00 Canadian). Otherwise, $5.00 shipping and handling for US orders/$10.00 Canadian.
If you or a friend would like to come in for a skin consultation, my Memphis Dermatology practice has been with Rheumatology and Dermatology, 8143 Walnut Grove Road, Cordova TN 38018 since 1993 (1-901-753-0168). Or you can find a Dermatologist closer to you by going to the American Academy of Dermatology website, https://www.AADA.org, then plugging your zip code into the “Find a Dermatologist” tab. Never itch in silence!