Lichen Planus in Women: Symptoms, Causes, and Treatment in the UK

Lichen planus is a relatively common inflammatory condition that affects the skin, hair, nails, and mucous membranes. In women, it often behaves as a chronic disorder, characterized by an itchy rash or painful lesions in the mouth and genital area. Unlike fungal infections or sexually transmitted infections (STIs), lichen planus is not contagious and cannot be passed to others through contact or sexual activity.

According to NHS guidance, lichen planus is most likely to affect adults over the age of 40. While the exact cause remains unknown, it is classified as an autoimmune-mediated condition, meaning the immune system mistakenly attacks healthy cells in the skin and lining of the mouth or vagina. The severity of the condition can vary greatly, with some women experiencing mild, transient rashes and others facing long-term, painful inflammation that requires specialist management.

The symptoms of lichen planus depend largely on which part of the body is affected. Women may experience the condition in one or several areas simultaneously:

• On the skin: Purple, flat-topped, firm bumps usually a few millimetres in diameter. These are often extremely itchy and commonly appear on the wrists, ankles, and lower back.
• In the mouth (Oral Lichen Planus): White, lace-like patterns on the inside of the cheeks, tongue, or gums. This can sometimes lead to painful sores or ulcers that make eating spicy or acidic foods difficult.
• Genital Lichen Planus: In women, this can cause bright red, sore areas or white patches on the vulva or inside the vagina. It can result in significant discomfort, burning, and pain during intercourse.
• Nails and Scalp: Thinned nails, ridges, or hair loss (lichen planopilaris) can occur in more systemic cases.

Medical researchers believe lichen planus occurs due to a complex interaction between genetics and the immune system. T-cells, a type of white blood cell, become overactive and attack a protein in the skin and mucous membranes. While there is no single trigger for everyone, the British Association of Dermatologists notes several factors that may aggravate the condition or play a role in its onset:

• Medications: Certain drugs for high blood pressure, heart disease, or malaria can trigger a lichen-planus-type rash.
• Stress: Emotional stress is frequently reported by patients as a factor that causes symptoms to flare up.
• Metallic Fillings: In rare cases of oral lichen planus, an allergy to mercury in dental amalgam fillings may be a contributing factor.
• Hepatitis C: There is a statistical link between lichen planus and the Hepatitis C virus, though this is less common in the UK than in other parts of the world.

In the UK, GPs follow NICE (National Institute for Health and Care Excellence) evidence-based pathways to diagnose and manage lichen planus. A diagnosis is often made by a physical examination of the rash and an assessment of your medical history. If the presentation is unusual, or if vulval lichen planus is suspected, a small skin biopsy may be taken to rule out other conditions such as lichen sclerosus or skin cancer.

Management typically follows a tiered approach based on severity. For mild skin lichen planus, the condition may resolve within 6 to 18 months without intensive treatment. However, for symptomatic cases, the primary goal is to reduce inflammation and relieve itching. This often involves potent topical corticosteroids (creams or ointments). For oral or genital lichen planus, which tend to be more persistent, specialists may prescribe antiseptic mouthwashes or immunosuppressant medications.

If you notice a new, itchy purple rash or persistent white patches in your mouth or genital area, it is important to seek medical advice. You can speak to a GP online to discuss your symptoms from the comfort of your home. This is particularly useful for initial assessments, as an online doctor can review photos of your skin or discuss your symptoms to determine the likely cause.

An online GP can provide guidance on over-the-counter itch relief, such as antihistamines, and may prescribe initial topical treatments if the diagnosis is clear. If your symptoms are severe, affecting your quality of life, or involving the genitals, the online doctor can facilitate a referral to a dermatologist or gynaecologist for a biopsy or specialist care. Early intervention is essential to prevent scarring, especially in the genital region, and to ensure you receive the correct treatment for lichen planus in the UK.

While waiting for treatment to take effect, several self-care measures can help manage lichen planus discomfort. Avoid washing the affected skin with harsh soaps; instead, use an emollient (a soap substitute). For oral symptoms, maintain excellent dental hygiene and avoid tobacco, alcohol, and spicy foods which can irritate mouth sores. If you have vulval lichen planus, wearing loose cotton underwear and avoiding scented feminine hygiene products can reduce irritation.

Most cases of skin lichen planus eventually clear up and do not return. However, mucosal lichen planus (in the mouth or genitals) can be chronic and may require long-term monitoring by a healthcare professional. In very rare cases, long-standing, untreated erosive lichen planus can slightly increase the risk of squamous cell carcinoma, which is why regular checks with a GP are recommended.