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Lichen Planus Mouth and Skin Patches in the Elderly

Lichen planus is a disorder affecting the skin and the oral cavity. It is marked by purple colored patches on the skin and inner lining of the mouth. The patches are usually itch. The mouth lesions are often diagnosed during routine dental checkups and can go unnoticed for a period of time. It is a precancerous condition, and has significant risk of developing oral cancer if left untreated. The elderly often mistaken lichen planus for age-related changes in the body, side effects associated with certain medication and the effects of long term cigarette smoking.

Is it lichen planus?

The symptoms of lichen planus are mainly seen on the skin and oral mucous membrane (inside the mouth). Both skin and oral lesions can be associated with pigmentation.

Skin symptoms

Skin lesions of lichen planus are generally seen on outer surface of the forearm and inner aspect of knees. The lesions are generally more prominent on upper body including scalp, nail-bed and genitals. Itchiness is typically present. New lesions may appear on scratching or sites with irritation or trauma. The lesions tends to regress and recur.

Mouth symptoms

The mouth lesions are usually seen on both sides of the mouth. Most common sites of development oral lesions are the inner aspect of cheek mucosa followed by tongue, lips, palate and gums. The lesion appears as a lace-like pattern. Clusters of diffused areas which are elevated purplish to red in color develop. The entire lesion resembles veins of a leaf. In certain types of lichen planus the lesions may be fluid filled or ulcerative. The lesion can also be in the form of a degenerative ulcer in certain cases.

Causes of Lichen Planus

Lichen planus is believed to be caused due to an abnormal immune response. It can be an auto-immune disorder or caused by immunodeficiency. Certain individuals may be genetically susceptible to develop lichen planus. The disease is more common in middle aged females but can sometimes arise in the senior years. The exact cause of the disease is uncertain, however certain factors show a strong association with its development.

Psychological stress is the major precipitating factor. Stress association is seen as the lesions tend to be more severe and painful on acute stressful conditions. Bacterial causes have also been suspected. A habit such as smoking and tobacco chewing predisposes an individual to develop lichen planus .Malnutrion, trauma, anxiety and depression are also associated with its development. Certain drugs and chemicals may also cause lesions mimicking lichen planus.

Lichen Planus Treatment

The treatment of lichen planus is a multi step process. Small lesions are treated with topical steroids such as beclomethasone, dipropionate spray and triamcinolone acetonide in gel or cream form. Antifungal agents can be applied over the lesion. Vitamin A supplements and balanced diet is advised to the patient.

Systemic administration of prednisolone is given in lesions affecting both skin and oral mucosa. Generally prednisolone is prescribed for duration of three weeks. In very severe and extensive lesions, direct injections of steroids into the lesion can be given. In lesions that are  unresponsive to conventional methods,  surgery is considered.

Factors precipitating stress related conditions and spicy foods are to be avoided. Lifestyle modifications, meditation and relaxation is advised.
Periodic recalls and check ups are mandatory to rule out development of oral cancer.

 


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