Lichen planus treatment — itchy purple skin bumps and oral lichen planus

Key facts

• Itchy, flat, purple bumps on wrists and ankles are typical
• Oral form: white lacy streaks or sore patches
• Biopsy may confirm atypical cases
• Potent steroid creams or gels are first-line
• Non-healing mouth ulcers need prompt examination

Recognising lichen planus on the skin

Skin lichen planus typically appears as small, flat-topped, shiny bumps with a purple or violet tone, often with fine white lines on the surface. Common sites are the inner wrists, forearms, ankles, lower back and shins. The bumps can be intensely itchy, and new ones may form along scratch lines. On darker skin, lichen planus frequently leaves brown or grey marks after it settles, which can take months to fade. It may also affect the scalp, causing patchy hair loss, the nails, causing thinning or ridges, and the genital skin. Lichen planus is an immune-related condition; it is not contagious and is not caused by poor hygiene.

Oral lichen planus and the dental team

Inside the mouth, lichen planus usually shows as white, lace-like streaks on the inner cheeks, sometimes with red, sore or ulcerated areas that sting with spicy or acidic food. Gums may look red and peel. Because the mouth is involved, Dr. Abdullah Anis can coordinate with Manhal's dental team, who check for sharp teeth, rough fillings or plaque that can aggravate the condition and help with gentle oral hygiene. Oral lichen planus needs long-term follow-up, because persistent ulcerated patches carry a small increased risk of changes in the lining of the mouth, so any area that changes or does not heal should be examined.

How the diagnosis is confirmed

Diagnosis is often made by examining the skin, mouth, nails and scalp. When the appearance is not typical, a small skin or oral biopsy may be advised so the tissue can be examined under the microscope. Dr. Abdullah Anis completed a fellowship in dermatopathology, which supports careful interpretation of biopsy results. Lichen planus-like rashes can also be triggered by certain medicines, and some studies have linked lichen planus with hepatitis C, so a review of your medicines and selected blood tests may be suggested depending on your history. Results are explained clearly before treatment begins.

Treatment options

For skin lichen planus, potent steroid creams or ointments applied to the bumps are the usual first step, alongside moisturisers and antihistamines for itching. Thick patches may be treated with steroid injections into the skin. For oral lichen planus, steroid gels, mouthwashes or pastes are used, and calcineurin-inhibitor ointments are sometimes added. Widespread or stubborn disease may need tablets that calm the immune system, or referral for phototherapy. Dr. Abdullah Anis explains how long to use each treatment, possible side effects and what follow-up is needed. Treatment is adjusted at follow-up visits according to how the skin and mouth respond.

Course, follow-up and when to seek care

Skin lichen planus often settles within one to two years, though it can recur, while oral lichen planus tends to be longer lasting with flares and quieter periods. Avoiding triggers such as spicy food during oral flares, stopping smoking and keeping regular dental check-ups help. Seek review promptly if a mouth ulcer does not heal within about three weeks, if a lump or thickened area appears, if you have difficulty swallowing, painful genital erosions or rapidly spreading hair loss. These signs need examination rather than waiting for the next routine visit.

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Prepared by the Manhal Medical Center editorial team · Updated: 2026-10-18 · Treating specialist: Dr. Abdullah Anis

This page is general information and does not replace a consultation. Suitability, risks and results vary between patients.