Lichen planus, a disease associated with human papilloma virus infection, occurs in adolescents. They occur on the face, back of the hands and forearms. Most of them appear suddenly as flat, elevated papules, smooth, round or oval, normal or light brown in color, in large numbers. In children with lichen planus, the rash is often seen in a beaded pattern. This is because scratching the skin at the rash can lead to self-inoculation of the virus, so the rash is arranged in a linear pattern along the scratch marks. Patients usually have no conscious symptoms, and the rash is not painful or itchy. The disease is slow and sometimes resolves on its own. Before it resolves, there is often an inflammatory reaction with significant itching, but it can also persist for years. The wart is usually not scarred after it disappears.
The treatment of warts is mainly divided into local and systemic treatment. For children with warts, topical treatment can be used initially and the child needs to be taught not to scratch the rash, as scratching is an important cause of virus transmission. The local treatment is divided into physiotherapy, chemotherapy and immunotherapy. Physical therapy includes liquid nitrogen freezing, electric drying therapy, and electrocautery. Physiotherapy is a relatively safe and fast method, but it requires the child to have a certain degree of autonomous behavior and be able to cooperate with the doctor during the treatment process, so it is not easily accepted by younger children. The chemical therapy includes the topical application of Chinese herbal medicine, 1-5% 5-fluorouracil cream, 3% phthalidone ointment, and retinoic acid ointment. These medications also work well for lichen planus, but usually require a longer time to work. Also, some of these medications may cause local irritation and allergy to the skin.
For generalized, uncontrollable lesions, systemic therapy may be considered, but the effectiveness of systemic treatment of lichen planus and its effect on the body’s normal immune system is controversial. Systemic treatment of pediatric patients can be done with medications such as BCG polysaccharide nucleic acid injections. The dosage and timing of medication needs to be directed by a dermatologist.
Lichen planus is a relatively common skin disease in children. It is not necessary to be overly aggressive in treatment. Initially, observation can be the main focus, while avoiding local scratching, as some childhood warts can subside on their own. If the number of rashes is large and increasing, then topical treatment should be used first. Children should avoid random systemic treatment.