Updated: 3/19/2017

Lichen Planus

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Snapshot
  • A 49-year-old woman with chronic hepatitis C infection develops a very itchy rash on her forearms, calves, and buccal mucosa. On exam, multiple polygonal, purple papules are found on the skin. The buccal mucosa shows a lacy, reticulated pattern. She has taken antihistamines with some relief of pruritis.
Introduction
  • An uncommon, pruritic, inflammatory lesion most commonly involving wrists, ankles, mucosa
    • 6 P’s 
      • pruritic
      • planar
      • polygonal
      • purple
      • papules
      • plaques
  • Epidemiology
    • affects women > men
  • Associated conditions
    • HCV, especially with mucosal involvement of lichen planus
Presentation
  • Symptoms
    • insatiable itch
  • Physical exam
    • skin
      • purple papule with angulated (polygonal) border
      • can have vesicles or bullae
      • can result in scarring alopecia
    • mucosa
      • white, lacy, reticulated patches in oral mucosa = diagnostic of lichen planus
        • known as Wickham striae
    • nail
      • dystrophic
Evaluation
  • Skin biopsy
    • sawtooth infiltrate of lymphocytes at dermal-epidermal junction
Differential
  • Psoriasis
  • Papular eczema
  • Discoid lupus (if scarring alopecia)
Treatment
  • Medical treatment
    • antihistamines for pruritus
    • topical steroids for localized disease
Prognosis, Prevention, and Complications
  • Prognosis
    • course is variable and unpredictable
  • Complications
    • < 5% of cases of oral lesions progress to squamous cell carcinoma
 

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