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Updated: Dec 26 2021

Lichen Planus

  • 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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