Diagnosis of Lichen Planus can be challenging due to its similarity to other dermatological and mucosal conditions.
Getting the right diagnosis is very important. It helps guide treatment and rules out serious conditions like oral cancer or autoimmune diseases. Symptoms can appear in many ways, depending on where they show up—on the skin, scalp, nails, or mucous membranes. That’s why doctors use a mix of patient history, physical checks, and tests to confirm the diagnosis of Lichen Planus.
The process usually starts with a detailed chat. The doctor asks about when the symptoms began, how they have changed, and what they feel like. Many patients report itchy, flat, purple bumps on the skin. Others mention painful sores in the mouth or genitals. Some feel burning in the mouth while eating spicy or sour food. Hair loss or nail changes might suggest the condition has affected the scalp or nails. Doctors also ask about any recent medicines, stress, or illnesses like hepatitis C, which may act as triggers.
Clinical Steps in the Diagnosis of Lichen Planus
After the history, the doctor does a full skin check. They look at the problem areas and gently touch them to feel their texture and spread. In many cases, the skin rash is enough to suggest lichen planus. But since it can look like other issues—such as eczema, psoriasis, lupus, or leukoplakia—extra tests often help confirm the diagnosis.
A skin biopsy is one of the most accurate ways to confirm the condition. The doctor takes a tiny sample from the skin or mucous tissue. Under a microscope, pathologists look for certain changes—like a group of immune cells near the skin layers and damage to the base layer of skin. These signs help confirm lichen planus and rule out other skin diseases.
Biopsies become even more important if there are sores in the mouth or genitals. These areas have a small risk of developing into cancer over time. So, in such cases, it’s crucial to watch them closely, even after a biopsy confirms the diagnosis.
Supporting Tests and Broader Checks
In some situations, doctors use a test called direct immunofluorescence. This test uses glowing dyes to spot immune proteins in the tissue sample. While not always needed, it can help tell lichen planus apart from other autoimmune diseases like lupus.
Blood tests may also be useful. For example, if the doctor thinks hepatitis C is involved, they may check liver function. Basic blood work can also reveal signs of inflammation or immune system activity.
For people with mouth sores, doctors may do swab tests to check for infections like thrush or herpes. Women with genital symptoms might need a pelvic exam or vaginal swabs to rule out infections or other conditions. These extra steps help make sure the diagnosis of Lichen Planus is accurate and complete.
Special Cases and Emotional Support in Diagnosis of Lichen Planus
Sometimes, the condition is more severe or unclear. In those cases, doctors refer patients to specialists. Dermatologists, oral health experts, or gynaecologists may be better equipped to deal with rare forms like erosive or thickened lichen planus. These forms may need special treatments.
The emotional impact of the diagnosis can be serious. Many people feel anxious, especially if the rash appears on the face, arms, or genitals. Counselling and clear explanations can help people understand what to expect. Knowing the condition is manageable can lower fear and boost confidence.
Doctors also need to find out if the lichen planus is idiopathic (with no known cause) or caused by medicine. Some drugs—like those for high blood pressure, malaria, or pain—can cause rashes that look like lichen planus. If a drug is the cause, stopping it can help the skin heal over time. That’s why checking medication history is an important part of diagnosis.
Conclusion
The diagnosis of Lichen Planus involves many steps. These include talking to the patient, checking the skin, looking at tissue under a microscope, and sometimes doing blood or swab tests. All of this helps the doctor figure out what type of lichen planus it is and what’s causing it. This allows for better, more focused treatment. Catching the condition early leads to better care and helps patients feel more in control of their health.
