What Is Lichen Planus and How to Treat It

If you look inside your mouth and you find lacy white patches, sometimes with redness or sores, on the inside of the cheeks, tongue, or gums, you may have the inflammatory condition oral lichen planus. Here is one way to treat it.

There’s an inflammatory autoimmune condition known as oral lichen planus, in which our immune system starts attacking the lining of our mouth. This is what it looks like. It’s actually not that rare. It strikes up to 5% of the population, particularly women, and about 1% of cases can turn into cancer. There’s no cure. There are just symptomatic treatments: steroids, immunosuppressants, and total glucosides of paeony. Like peony peony? Yes, medicinal properties in the root of the common garden peony. That’s neat. But are there any edible plants that may help?

There’s a plant called purslane, one of the most common weeds in the world—you can see it growing out of the cracks in the sidewalk everywhere you look, once you start looking. Its healing properties were thought to be so reliable that Roman savant Pliny the Elder advised wearing the plant as an amulet to expel all evil. I don’t know about that. What about just eating it?

A randomized, double-blind, placebo-controlled trial found that 83% of those in the purslane group experienced partial or complete clinical improvement, compared to 83% in the placebo group who either didn’t respond or got worse. So, this simple weed appears to be clinically effective in the treatment of oral lichen planus with no side effects. In a comparison to the efficacy and safety of nine different treatments, including steroids and immunosuppressants, purslane appeared to be not only the safest but the most effective treatment available, with only good side effects––lowering triglycerides and decreasing inflammation.

You can overdo it, though. Purslane is a high-oxalate green, with nearly half as much oxalates as spinach. So, even if you don’t tend to get kidney stones, you don’t want to eat four pounds (2 kg) of purslane at a time. I know it’s delicious, but as little as a pound and a half (0.70 kg) at a time, or even two pounds (0.90 kg) spread out over two meals, could potentially overload the kidney and cause damage.

Purslane can even fight lichen planus topically. A purslane gel appeared to work as well as topical steroids, the gold standard treatment. The researchers concluded that purslane is a “magical” herb, beneficial, lacking side effects, and therefore can be a safer alternative drug in oral lichen planus treatment. But by alternative “drug,” they’re just talking about a weed that grows for free all over.

In our next story, we look at additional ways to treat lichen planus.

Lichen planus is a “chronic autoimmune disease,” typically of our moist membranes, such as the inside of our mouth, but can also affect other body surfaces.

“Current treatments…are not curative but [rather palliative,] aimed at relieving pain.” We’ve tried steroids, antibiotics, chemotherapy, and surgery, and none appear to be particularly effective. So, even for palliative pain relief, we don’t have great options; so, that’s why case reports like this are so exciting. After drinking two ounces of aloe vera juice a day and applying aloe topically as well.

But, is ingested oral aloe vera a “potion or poison?” “Internal use of aloe may cause acute hepatitis”—liver inflammation—as well as electrolyte imbalances, and you should definitely not inject aloe. “[B]ut oral use is also not recommended,” either.

This is primarily because of case reports of aloe-induced hepatitis. Aloe is, ironically, “presented as a detoxifying product,” but can actually end up causing liver damage. How do we know it was the aloe, though?

The assessment of suspected herbal-induced liver injury is challenging, because there’s hundreds of things out there that can damage your liver. Here’s the kind of checklist you have to go through as a doctor to rule out other causes before you blame it on the plant. Do you have some kind of viral hepatitis, or other kind of liver infection? Or, it could be various drugs or toxins or diseases. So, maybe it was one of these other things, and it was just a coincidence that the problem started after drinking aloe. The gold standard, in terms of trying to prove cause-and-effect, is a “positive re-exposure test”—that’s how you can diagnose drug-induced liver injury. Liver inflammation disappears when you remove the drug, and then reappears when you add the drug back, which is rarely done, for obvious reasons.

Well, has there ever been a re-challenge case published for aloe? Yes. Aloe-induced toxic hepatitis that shot up again after stopping and then restarting aloe ingestion.

Aloe consumption has also been “linked to thyroid dysfunction.” A women with lichen planus started swallowing two teaspoons of aloe vera juice a day. She started feeling “unjustifiably tired.” Lab work showed her thyroid function was low, but she perked right back up after stopping the aloe, and her thyroid function returned to normal. What if, instead of swallowing, though, she just swished the aloe around in her mouth to try to help the lichen planus, and then spit it out? We didn’t know, until it was put to the test.

A randomized, double-blind, placebo-controlled trial: 54 patients randomized to a topical aloe vera gel or placebo gel for eight weeks. 81% in the aloe group got better, compared to just 4% in the placebo group. “Furthermore, two patients treated with [aloe] had a complete clinical remission.” That’s rare. It’s considered a chronic condition; yet, a few weeks applying aloe, and the nasty erosive lesions disappeared.

How about compared to a steroid ointment though? Topical aloe vera gel was superior—”more effective” than the steroids, a significant difference appearing within two weeks. So, “[a]lthough corticosteroids are still [considered] the gold standard, aloe vera shows promising results especially with no adverse effects [when applied topically] compared with various adverse [side] effects of corticosteroids.”

That’s for oral lichen planus, though. What about the efficacy of aloe vera gel in the treatment of lichen planus of the genitals? Lichen planus of the vulva “is quite common, affecting 1-2% of the population,” and it may be even harder to treat. “There are flares and partial remission but no tendency for complete remission.” And, indeed, that’s what they saw in the placebo group. One woman had a good response, but most had little or no response, but applying aloe vera gel instead, and nine out of ten responded, and one woman had a complete clinical remission. They conclude that “[a]loe vera gel [is] a safe and effective treatment.”