Lichen planus; simple condition and treatable
Welcome again to the forum and thanks for intimating all the important information along with important pictures so that I can now guide you best regarding your condition.
After thoroughly analyzing all the pictures I can make out that you have the condition of “Lichen planus” which is one of the very simple, treatable and curable skin condition.
To tell you elaborately about your problem- Our skin is multilayered structure which is divided into epidermis and dermis. The epidermis is further divided into more layers. These layers are renewed regularly. Sometimes due to an autoimmune injury (production of antibodies
against our skin) to these layers, there is an internal skin damage which is expressed in form of red to violaceous skin lesion which can occur at mucous membranes (inside the mouth or genitalia) and on skin surface.
You must be wondering that what exactly caused the problem or what are the causative agents or why this kind of autoimmune injury developed. In most of the cases we are not able to find out the cause but in identifiable causes there are certain drugs and chemical agents. These chemical agents breaks the protective barrier and therefore the antibodies are formed against our own skin layers.
In you I can correlate Nicotine gum as an important chemical factor started almost 3 months before the starting of the problem. Though it is not confirmatory but there are multiple reports of Lichen planus like problem after nicotine gums.
So it would be worth if you can stop the gums for few weeks and observe the improvement accordingly.
For the main part of treatment- If I were your dermatologist
then would have preferably started with halobetasol
cream first on the affected areas. Once there is decrease in the size and shape of the affected area in few weeks then would have shifted to moderate potency steroid such as mometasone
for next few weeks and then maintained with low potency one such fluticasone
cream. These creams do not cause any systemic problem if used properly.
For oral therapy
- Though oral steroids are the mainstay of treatment but are to be used judiciously and carefully. This is only required to halt the further progression. If you do not have any increase in new area then you need not to take the same.
As scratching the skin induces formation of new lesions so in my experience for oral therapy antihistamine provides the best relief for relief. These drugs are safest of all and reduce the itch and an urge to scratch. If I were treating you then I would have preferred for loratadine
tablet to relieve itching. You can start with one to two tablets if there is moderate itching and can be increased to 3 times if it is higher. I also suggest you to not to scratch the areas because of the reason told above.
I quite often see your kind of problem and in most of the cases it gets completely alright in maximum of 2 years. It is not a lifelong problem and not at all life threatening too. So do not worry about any type of grave possibilities which never occurs.
Do not take stress of any type as stress itself can aggravate the problem.
I hope these information will relax your mind. I will glad to answer any further queries or if not then can close the discussion and rate the answer.
"Wish you good health"
Dr Sanjay Kumar Kanodia