April 29, 2010 in Features

Dr. Gott: Lichen planus diagnosis raises questions

Peter H. Gott, United Media

DEAR DR. GOTT: I am an 80-year-old female diagnosed with lichen planus. Other than being told it is an autoimmune disease, the dentists and doctors I have visited have no idea what to do with me. I have a white coating in my mouth on the bottom gums and occasionally break out with water blisters on my legs.

I am writing to you as a last resort for help. I have read on the computer that it is short-lived, but may come back. I have had it for three years now, and while it doesn’t always cause pain, it is annoying. Can you offer any suggestions or aid?

I once sent away for pills that were supposed to rid me of it, but they did nothing to help and they were expensive – $65 for a 30-day supply. I think they were some kind of herb.

DEAR READER: Perhaps your “last resort” will solve the problem. The precise cause of lichen planus remains unknown. As you are aware, it is thought to be related to an autoimmune disease or allergy and presents with mouth and skin lesions. The mouth lesions can be painful, may increase in size and are located on the sides of the tongue, inside the cheek, and occasionally on the gums. Skin lesions have distinct borders, can develop blisters or ulcers, are shiny or scaly in appearance, and are symmetrical and itchy. Risks include exposure to gold, some diuretics and antibiotics, other medications and hepatitis C. A physician makes the diagnosis through visual examination.

Related symptoms are ridges in finger and toenails, a metallic taste in the mouth, hair loss and dry mouth.

Treatment includes apple-cider vinegar or lidocaine mouthwashes, antihistamines, cyclosporin or other immune-suppressing medications, topical or oral corticosteroids, topical ointments or creams and ultraviolet-light therapy.

The prognosis is good in that lichen planus isn’t generally harmful and should get better with treatment. It commonly clears up within 18 months, but can come and go for years.

DEAR DR. GOTT: My 45-year-old daughter told me that when she moves her bowels, the feces are a greenish color. What causes this?

DEAR READER: Variations in diet can lead to green stool. Green, leafy vegetables contain chlorophyll. Foods with purple coloring such as ice pops or gelatin desserts can turn stool rainbow colors. Foods rich in iron or iron supplements can also modify the color.

Bile is secreted in the small intestine and is green in color. Normally, the stool turns brown as it passes through the large intestine. However, if it passes faster than normal, it may be expelled while still green.

If your daughter’s stool remains green and diet or supplements are not a factor, she should make an appointment with a gastroenterologist for follow-up just to ensure there are no other problems that need to be addressed.


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