October Blog Special: Extrahepatic Manifestations of Hepatitis C—Lichen Planus
Foreword: Lichen planus is a fairly common skin disorder that lasts for months to years. Lichen planus affects about 1 to 2% of the U.S. population and usually affects people between the ages of 30 and 70 years old. It is slightly more prevalent in women than in men. The exact cause of lichen planus is unknown. However, lichen planus is known to be triggered by stress, genetics, allergic reactions to medicines, and by viral infections such as hepatitis C. The onset may be gradual or fast.
There have been studies that have found the prevalence of HCV in people with lichen planus is 16%. For this reason, it has been recommended that people with lichen planus should be tested for hepatitis C.
The high prevalence of hepatitis C in people with lichen planus should be a wake-up call to test, treat and cure people with hepatitis C to prevent lichen planus, other extrahepatic manifestations, and the many disease consequences of hepatitis C.
Discuss any symptoms with your medical provider and be sure to have all of your symptoms or conditions recorded in your medical records. If you are not approved for the drugs to treat hepatitis C, you may qualify for free medications or co-pay assistance through a pharmaceutical patient assistance program or other assistance programs. More information is available at the end of this article.
Lichen planus typically affects the skin, nails, vulva, penis, and mucous membranes including the mouth. The symptoms appear as purple or plaque-like shiny flat-topped itchy bumps.
Lichen planus is not an infectious disease–that is it is not transmitted to others. There is no cure for lichen planus, but treatment is effective in alleviating the symptoms such as the itching of the skin lesions and improves the appearance of the rashes. Also, specific treatments can help with some of the symptoms associated with lichen planus. There are some symptoms will naturally resolve, however, since lichen planus cannot be cured, the condition may return.
Oral: Oral lichen planus is an inflammatory condition that affects the lining of the mouth, usually on the inside of the cheeks, but it can also affect the gums, tongue and inner cheeks of the mouth. Although rare it can also affect the throat or esophagus.
The symptoms appear as white, interconnecting lines which resemble and are named after the lichen plant, but lichen planus is NOT related in any way to the plant. Severe cases may involve painful sores and ulcers in the mouth. Very severe cases of lichen planus of the mouth can slightly increase the risk of oral cancer. Lichen planus that affects the mouth can be diagnosed by a dentist or dental hygienist. The diagnosis can be confirmed by a biopsy. Yeast infections are commonly found in association with lichen planus or can be triggered by topical steroids used to treat it. Treatment of the yeast infection sometimes improves the symptoms of oral lichen planus.
It is important to control the disease with medications, good oral hygiene, and regular physical exams to monitor any changes. Alcohol, tobacco, spicy foods, peppermint, cinnamon, citrus type foods and stressful situations trigger the symptoms and should be avoided if possible.
Skin: Lichen planus most commonly affects the skin–including the genitals. The symptoms include bumps that can appear on any skin surface but are most often found on the inside of the wrists and ankles, the lower legs, back, and genital regions. In severe cases, the bumps can be extremely itchy and painful. When the lesions heal, the skin may become discolored. The skin discoloration usually fades but may cause scarring especially when the scalp is involved.
There are many strategies to reduce the symptoms including the use of oatmeal baths (Aveeno), cold compresses to the affected area of the skin, and anti-itch topical creams. The most common treatments include topical steroids and antihistamines used to relieve the itching. Severe cases may require the use of oral corticosteroids such as cortisone or prednisone. Extreme cases may need photo chemotherapy light treatment and prescription drugs to help control and alleviate the symptoms.
Hair: Lichen planus can affect the scalp and hair. The symptoms of skin lichen planus include hair thinning, redness of the scalp and hair loss can occur. If left untreated it can cause permanent scarring and inflammation of hair follicles leading to permanent hair loss (alopecia). To prevent permanent hair damage use oral steroids, plus topical steroids, as well as prescribed oral medications. They should be taken as soon as possible to avoid permanent damage.
Nails: Lichen planus can also affect the nails leading to damage of the nail root. Symptoms include nail splitting, grooving of the surface of the nail and the nails can become thin and brittle and possible nail loss. In severe cases, the nail loss can result in permanent nail root damage. Severe cases are treated with a combination of approaches that include immunosuppressive drugs.
Note: some of the medications discussed in this article may not be liver friendly. Discuss all medications you are taking with your medical provider and a liver specialist to find out if they are safe.
To view our Extrahepatic Manifestations Glossary, click here
To view our Hep C Medications Blog, click here
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