Updated: 12/12/2019

Lichen Planus

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Snapshot
  • A 36-year-old woman presents to her primary care physician due to intense pruritic lesions affecting her ankles and wrists. She reports that this has never happened before. Medical history is significant for prior hospitalization for sepsis secondary to methicillin-resistant staphylococcus aureus (MRSA) in the setting of intravenous drug use. Her only medication is methadone and she does not have any allergies. On physical examination, there are polygonal violaceous papules affecting the ankles and volar surfaces of the wrists. Upon closer inspection of the lesions there are Wickham’s striae.
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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