Video/Lichen planus/Hepatitis c

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Video/Lichen planus/Hepatitis c

Lichen planus has been reported as a complication of chronic hepatitis C virus infection and can be a sign of chronic graft-versus-host disease of the skin.

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Lichen Planus (LP) The reported incidence of hepatitis C virus associated lichen planus ranges from 0.1% in urban areas to 35% in endemic areas such as Italy or Egypt. Of the subtypes of lichen planus, the erosive mucosal variant has the greatest association with Hepatitis C.

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Clinically this can present with painful, erosive gingivitis or mucosal ulcerations with Wickham’s striae. The pathogenesis is thought to be the result of HCV growth and replication within lymphocytes. Unfortunately, mucosal ulcerative LP does not spontaneously regress as one sees in cutaneous lichen planus involving skin only.

Mucosal Lichen Planus

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Cutaneous Lichen Planus

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What is lichen planus?All About an HCV-Related Condition: Lichen PlanusLichen planus, a recurring skin condition that often manifests with Hepatitis C infection, can cause intense itching and pain. Learn about the skin disease's characteristics and commonly affected regions - as well as six strategies that may help reduce your risk of lichen planus from returning.by Cutler, L.Ac.Affecting between one and two percent of the world's population, lichen planus is a relatively common dermatological disease. A recurring, chronic, non-allergic, non-infectious, non-contagious disease of the skin, lichen planus has a tendency to relapse after months or years. In between episodes, practicing preventative measures may be able to stop the recurrence of this frustrating condition.The exact cause of lichen planus is unknown, but it seems to be

triggered by stress, genetics, viral infection and allergic reactions to medicines. Although it can be associated with many different health conditions, lichen planus is a common manifestation of Hepatitis C infection. Studies have found that up to 60 percent of people with lichen planus have a history of Hepatitis C. For this reason, it has been recommended that people with lichen planus (especially with elevated liver enzymes) should be tested for the Hepatitis C virus.About Lichen PlanusArriving in episodes lasting months to years, lichen planus may begin gradually or quickly. Although no specific cause can be singled out, many possible sources have been implicated in its evolution. Found to occur more frequently in people with a liver dysfunction, lichen planus is now recognized as an extra-hepatic manifestation of the Hepatitis C virus.Often times, a physician must perform a

biopsy of affected tissue to confirm a diagnosis of lichen planus. Unfortunately, several biopsies may be needed at various times, along with blood tests. Clinicians seem to agree that it is common for a yeast infection to be present with lichen planus. In such cases, treating the yeast infection first often improves the severity of lichen planus.Below are eight characteristics of lichen planus:1. Appearing as shiny, flat-topped bumps typically with an angular shape, the bumps of lichen planus have a reddish-purplish color and a shiny cast.2. Even though it favors the inside of the wrists and ankles, the lower legs, back and neck, lichen planus can surface anywhere on the skin.3. The mouth, genital region, hair and nails may be lichen planus targets in some individuals.4. Thick patches may occur, especially on the shins.5. Blisters rarely occur.6. Bumps typically appear in areas of

trauma.7. About 20 percent of the time, lichen planus of the skin causes minimal symptoms and needs no treatment.8. In many cases, the itching of lichen planus can be constant and intense.There is no known cure for skin lichen planus, but treatment is often effective in relieving itching and improving the appearance of the rash until it goes away. Since every case of lichen planus is different, no one treatment is sufficient. Physicians may prescribe oral or topical corticosteroids, antihistamines, retinoid drugs or photo-chemotherapy light treatment (PUVA).Other LocationsCommonly seen with Hepatitis C infection, lichen planus affects other regions of the body such as the mouth, scalp and nails:· Lichen Planus of the Mouth - Lichen planus lesions can be found on the inside of the cheeks, gums and tongue. Called oral lichen planus, this variety can be more

difficult to treat and typically lasts longer than skin lichen planus. About one-third of all people who have oral lichen planus also have skin lichen planus. Typically appearing as patches of fine white lines and dots, oral lichen planus rarely causes symptoms. However, severe forms of oral lichen planus can cause painful sores and ulcers in the mouth.· Lichen Planus of the Nails - Reported in about 10 percent of lichen planus cases, nails can also be affected by this condition. The majority of toenail or fingernail changes results from damage to the nail matrix, or nail root. Nail changes associated with lichen planus include longitudinal ridging, grooving, splitting, nail thinning and nail loss. In severe cases, the nail may be temporarily or permanently destroyed. Lichen planus of the nails is often resistant to treatment.· Lichen Planus of the Scalp - Lichen Planopilaris is the specific name given to lichen planus on the scalp,

which causes permanent scarring alopecia with inflammation around affected hair follicles. Mostly affecting middle-aged adults as distinct patches of hair loss, treatment includes oral and topical steroids.Relapse PreventionBesides avoiding potentially aggravating medications, most clinicians woefully report that there is no surefire way to prevent the recurrence of lichen planus. However, the growing understanding that this skin disorder is an extension of an immune system deficiency offers some clues. In addition, the fact that treating a yeast infection is beneficial for lichen planus, gives us even more useful information.By keeping your body - both the physical and emotional extensions - as healthy as possible, your risk of a severe lichen planus outbreak is reduced. On top of controlling any possible lichen planus triggers, six suggestions for accomplishing this

include:1. Do whatever is necessary to minimize stress.2. Avoid alcohol and tobacco.3. Prioritize getting a full night of restful sleep.4. Choose foods that are digestive system friendly, such as whole grains, vegetables, fruits, high-fiber and items low in saturated fat.5. Reduce peppermint, cinnamon and citrus foods (as these may aggravate lichen planus).6. Fight yeast accumulation with probiotics. According to Israeli researchers, probiotics are immune system modulators. In addition to strengthening the digestive system to combat yeast, probiotics have also demonstrated an improved ratio of immune cell factors.This potentially frustrating skin disease can really be a challenge, especially while trying to manage chronic Hepatitis C. Since Hepatitis C and lichen planus commonly appear together, looking for solutions to benefit both ailments is the best choice. In addition to working with your

physician to minimize any lichen planus triggers, evaluate what you are doing to keep your emotional, digestive and immune systems healthy. Even if you are struggling with an outbreak, instituting the above listed six suggestions will pay off in the long run - by reducing the risk of future lichen planus episodes and by improving your overall physical health.Amital H., et al., Probiotic Supplementation with Lactobacillus casei (Actimel) Induces a Th1 Response in an Animal Model of Antiphospholipid Syndrome, ls of the New York Academy of Sciences, September 2007.http://autoimmune-skin-disorders.suite101.com/ , Lichen Planus: A Common Skin Rash in Autoimmune Disorders, Elaine , April 2007.http://hcvadvocate.org/ , Extrahepatic Manifestations: Lichen Planus, Alan Franciscus, Hepatitis C Support Project, 2007.Prabhu a, Pavithran K, Sobhanadevi G, Lichen planus and hepatitis c virus (HCV) - Is there an

association? A serological study of 65 cases, Indian Journal of Dermatology, Venereology and Leprology, 2002.www.aafp.org, Lichen Planus, Rajani Katta, MD, American Family Physician, 2007.http://www.aocd.org/ , Lichen Planus, American Osteopathic College of Dermatology, 2007.www.lichenplanus.com, What you Need to Know About Lichen Planus, Dr. Rajesh Shah, 2007.

Lichen planusLichen planus is a relatively common inflammatory disease that affects the skin and/or inside the mouth, resulting in distinctive skin and/or oral lesions. Lichen planus of the skin usually causes itching. There seems to be a relationship between the oral form and the skin form of lichen planus. Almost half of those with the oral version also have skin lesions. The onset may be gradual or quick, but the exact cause of the inflammation that leads to lichen planus is not yet fully understood. It is important to note that lichen planus itself is not an infectious disease. Therefore, this disease is not passed from one person to another by any means. Lichen planus is not a type of cancer.Who gets lichen planus?Lichen planus affects around one percent of the general population. Both men and women can get

lichen planus. Skin lichen planus affects men and women equally, but oral lichen planus affects women twice as often as men. Although it may occur at any age, it usually affects middle-aged adults. It is uncommon in the very young and elderly. This disease can affect any individual all over the world, regardless of the race, skin color and culture.What are the signs and symptoms of lichen planus?Lichen planus of the skin appears as small, flat-topped, red-to-purple bumps with round or irregular shape. You may have just a few small bumps or you may have many. If you take a closer look, you might see white scales or flakes on them. Some may have wispy, gray-to-white streaks called Wickham's Striae. Lichen planus causes itching with an intensity that varies in different people from mild to severe. Sometimes the bumps don't itch, but typically they do. Lichen planus can appear on any area of

the skin. The most common areas are the inner wrists, the forearms and the ankles. It may also affect the scalp?or the nails. On the scalp, it may cause redness, irritation, and, in some cases, hair loss. Sometimes this disease affects the areas of skin where you had a trauma, such as a superficial scratch, cut, or burn. Lichen planus of the nails can cause brittle or split nails, and the affected nails may have ridges running lengthwise. In the mouth, lichen planus looks like lacy white patches on the inside of the cheeks or on the tongue. Oral lesions do not usually cause symptoms, though severe outbreaks may cause painful sores and ulcers that make it hard to eat and drink. Lichen planus can affect the female genitals, including the vagina. In the vulva or vagina, it may appear as bright red patches or sores. Such condition can be confused with sexually transmitted diseases, although lichen planus is neither sexually transmitted nor contagious as

mentioned above. Genital lichen planus does not usually cause symptoms, but open sores may be quite tender.What cause lichen planus?In most cases, the cause of lichen planus can't be found. It is not caused by stress, but sometimes emotional stress makes it worse. This disorder has been known to occur after contact with certain chemicals, such as those used to develop color photographs. Some cases of lichen planus may be linked to chronic hepatitis C virus infection. This virus can cause serious liver diseases, such as liver cirrhosis and liver cancer. Your doctor may need to order a blood test to check for hepatitis C virus. In some people, certain drugs cause lichen planus. These drugs include medications for high blood pressure, heart disease, diabetes, arthritis and malaria, antibiotics, non-steroidal anti-inflammatory pain

killers, etc. It is important to tell your doctor all the medicines you are taking. The rashes will go away after the offending drug is stopped. People who have lichen planus in the mouth may be allergic to certain products used during dental procedures, such as amalgam fillings. Patch testing may be used to specify the allergy; removal of dental material is recommended and may result in cure.How is lichen planus diagnosed?The diagnosis of lichen planus is often made by a dermatologist, oral surgeon or dentist on the basis of the typical clinical appearance. A skin biopsy may be needed to confirm the diagnosis. In case of oral lichen planus, your physician may have to make sure that the lesions are not caused by yeast, and a biopsy is often recommended to confirm or make the diagnosis and to rule out other oral diseases including cancer (see below). For a biopsy, a small bit of skin or

mucosa is taken from the lesion. It is sent to a laboratory to see if it is actually lichen planus by microscope.How is lichen planus treated?Most of the time, the bumps go away without any treatment after about a year. However, treatment can make your skin look better. The goal of treatment is to reduce your symptoms and speed healing of the skin lesions. If symptoms are mild, no treatment may be needed. There is no known cure for skin lichen planus, but treatment is often effective in relieving itching and improving the appearance of the rash until it goes away. Lichen planus of the scalp must be treated right away, or the hair of the affected area may never grow back. Since every case of lichen planus is different, no one treatment does the job. Topical corticosteroids are very useful. You can use a corticosteroid ointment or cream that you apply directly to the bumps. Corticosteroids

may be injected directly into a lesion. In the mouth, steroid pastes or inhalant powders may be easier to apply to affected sites. Hydrocortisone foam can be used inside the vagina. Antihistamines may be prescribed to relieve itching. Extensive cases may require the use of oral corticosteroid for a few weeks or longer. This usually shortens the duration of the outbreak, but may have serious side effects. Ultraviolet light therapy (also called PUVA) may be beneficial in some cases. The so-called immune modulating drugs, tacrolimus ointment and pimecrolimus cream, may be useful for oral and genital lichen planus. Other treatment options include topical or oral retinoid (a form of vitamin A), long term antibiotics, oral antifungal agents, phototherapy, methotrexate, hydroxychloroquine, etc.What is the long-term outlook for lichen planus?In general, lichen planus is not a harmful or fatal

disease. It usually goes away by itself in time, but can persist for a long time, running into years, and this varies from patient to patient. The presence of skin lesions is not constant and may wax and wane over time. Oral lesions tend to last longer than those of the skin. Furthermore, even after going away completely, lichen planus may recur. As it heals, lichen planus often leaves a dark brown discoloration of the skin. Like the bumps themselves, these stains may eventually fade with time without treatment. When oral mucosa is affected by lichen planus, there is a slightly increased risk of developing oral cancer. If oral lichen planus is present, you should avoid the use of alcohol and tobacco products, which also increase the risk. Regular visits to the dermatologist or dentist — at least twice a year — for an oral cancer screening is recommended. http://www.americanskin.org/resource/lichen.php

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In case you missed it...........

..,Hepatitis C Associated Skin Conditions Study/Association of lichen planus with hepatitis C virus infection.

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