Lichen planus can look different depending on where it occurs. On the skin, it commonly shows up as small, flat-topped bumps that may look purple, violaceous, or reddish-brown, and it often itches. These bumps can merge into thicker patches (plaques) and may appear on areas like the wrists, ankles, lower back, and legs. Some people notice fine white lines on the surface of lesions (called Wickham striae).

Lichen planus can also affect other areas:

• Mouth (oral lichen planus): white, lacy patches on the inside of the cheeks or tongue, sometimes with burning, soreness, or open sores.
• Nails: ridging, thinning, splitting, or (less commonly) nail loss.
• Scalp: itchy bumps and irritation that may lead to hair thinning or hair loss in certain variants.
• Genital area: irritation, discomfort, or painful erosions in some cases.

Because symptoms overlap with eczema, psoriasis, yeast infections, and other rashes, a dermatology evaluation is important especially if symptoms persist, spread, or involve the mouth or genitals.

The exact cause isn’t always clear, but lichen planus is widely considered an immune-mediated inflammatory condition. In some people, it may be related to immune system activity that targets skin or mucosal tissue.

Potential contributors and triggers can include:

• Genetic and immune factors (some people may be more predisposed)
• Medication reactions in certain cases (a “lichenoid” drug eruption can mimic lichen planus)
• Stress or illness, which may coincide with flares for some individuals

Even when a specific trigger isn’t identified, the good news is that many cases can be managed effectively, and skin-only lichen planus may improve over time.

At Peak Skin Center, diagnosis typically starts with a detailed history and a focused skin and/or mucosal exam. Dr. Knackstedt and the team will look at the distribution, color, texture, and pattern of the rash, as well as any mouth, nail, scalp, or genital symptoms.

In some cases, your provider may recommend:

• Skin biopsy to confirm the diagnosis and rule out similar-looking conditions
• Review of current medications if a drug-related rash is suspected
• If mouth symptoms are present, careful evaluation of the oral tissues and collaboration with dental/oral medicine resources when appropriate

Treatment depends on where lichen planus occurs, how severe symptoms are, and whether it’s active or improving. The main goals are to reduce inflammation, control itch or pain, and help the skin or mucosa heal.

Topical therapies (often first-line):

• Topical corticosteroids (creams/ointments) are commonly used to reduce inflammation, discoloration, and itching on the skin.
• For sensitive areas (like the face) or certain cases, topical calcineurin inhibitors (tacrolimus or pimecrolimus) may be recommended to help reduce bumps and discomfort.

Oral lichen planus support:

Oral lichen planus can be more persistent and may require targeted treatment such as steroid gels/rinses or other prescription therapies to reduce soreness and inflammation.

Phototherapy and systemic options (for more widespread or resistant cases):

If topical therapy is not enough, the Peak Skin Center team may discuss options such as light therapy or other prescription anti-inflammatory medications, selected carefully based on your health history.

Comfort and skin-care strategies:

Your plan may also include gentle skin-care guidance to reduce irritation, avoid triggers that worsen itching, and support the skin barrier while treatment works.