Lichen planus

Last updated: May 8, 2023

Summarytoggle arrow icon

Lichen planus is a chronic inflammatory disease of unknown origin, which most commonly affects individuals between 30–60 years of age and is characterized by different types of lesions involving the skin and mucosa. The most common lesions are purple papules with well-demarcated, irregular borders, which typically occur on the wrists, lower extremities, and genitoanal region. The surfaces of the lesions often exhibit a pattern of white lines known as Wickham's striae. The disease is diagnosed clinically, but may be confirmed through dermoscopy and punch biopsies. Biopsy also helps detect squamous cell carcinoma, the risk of which is increased in lichen planus. Treatment primarily consists of high-dose topical steroids but may also include oral steroids and phototherapy in cases of extensive or steroid-refractory disease. Lichen planus is generally a chronic-recurrent condition, except for the cutaneous form, which is usually self-limiting.

Epidemiologytoggle arrow icon

  • Prevalence: rare disease (occurs in < 1% of the population) [1][2]
  • Age of onset: 30–60 years [3][4]
  • Sex [1]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Although the exact etiology of lichen planus is unknown, possible etiologic factors include:

Clinical featurestoggle arrow icon

Lichen planus can affect the skin, mucosa, scalp, genitalia, and nails, and manifests with varying symptoms depending on the subtype of the disease.

Cutaneous lichen planus [2]

May occur simultaneously with other subtypes

  • Lesions
    • Purple, well-demarcated papules or plaques
    • Planar (flat-topped)
    • Polygonal, irregular borders
    • Pruritic, often severe
    • Wickham striae: white, reticular lines on the surface of mucosal lesions
  • Distribution pattern
    • Affects the extremities, especially the ankles and flexor wrists, as well as the trunk
    • Lesions arranged in linear or circular groups that may coalesce into larger plaques
    • Bilateral, symmetrical distribution [8]
    • Lesions often develop in previously traumatized skin (Koebner phenomenon)

Mucosal lichen planus

Genital lichen planus

The 6 P's of lichen Planus are: Pruritic, Polygonal, Planar (flat-topped), Purple Papules, and Plaques.

Subtypes and variantstoggle arrow icon

Lichen planus can manifest with several subtypes, including: [8]

Diagnosticstoggle arrow icon

Lichen planus is clinically diagnosed based on the presence of typical skin lesions. Additional testing is performed to confirm the diagnosis and rule out other diseases.

Pathologytoggle arrow icon

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

Prognosistoggle arrow icon

Any localization of erosive lichen planus can cause scarring, which may lead to functional limitations.

Referencestoggle arrow icon

  1. Le Cleach L, Chosidow O. Clinical practice. Lichen planus.. The New England journal of medicine. 2012; 366 (8): p.723-32.doi: 10.1056/NEJMcp1103641 . | Open in Read by QxMD
  2. Katta R. Lichen Planus. Am Fam Physician. 2000; 61 (11): p.3319-3324.
  3. Gunnar Wagner, Christian Rose, Michael Max Sachse. Clinical variants of lichen planus. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2013.
  4. Wagner G, Rose C, Sachse MM. Clinical variants of lichen planus.. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG. 2013; 11 (4): p.309-19.doi: 10.1111/ddg.12031 . | Open in Read by QxMD
  5. Nelson L Rhodus, Bin Cheng, Frank Ondrey. Th1/Th2 cytokine ratio in tissue transudates from patients with oral lichen planus. Mediators of Inflammation. 2007.
  6. Lehman JS, Tollefson MM, Gibson LE. Lichen planus.. Int J Dermatol. 2009; 48 (7): p.682-94.doi: 10.1111/j.1365-4632.2009.04062.x . | Open in Read by QxMD
  7. Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W. Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis.. Arch Dermatol. 2009; 145 (9): p.1040-7.doi: 10.1001/archdermatol.2009.200 . | Open in Read by QxMD
  8. Gorouhi F, Davari P, Fazel N. Cutaneous and mucosal lichen planus: a comprehensive review of clinical subtypes, risk factors, diagnosis, and prognosis. ScientificWorldJournal. 2014.doi: 10.1155/2014/742826 . | Open in Read by QxMD
  9. James WD, Berger T, Elston D. Andrews' Diseases of the Skin: Clinical Dermatology. Elsevier Health Sciences ; 2015
  10. Ziemer M, Mockenhaupt M, Corona R. Lichenoid Drug Eruption (Drug-Induced Lichen Planus). In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: December 9, 2016. Accessed: May 17, 2017.
  11. Goldstein BG, Goldstein AO, Mostow E, Dellavalle RP, Callen J, Ofori AO. Lichen Planus. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: January 11, 2017. Accessed: May 17, 2017.

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