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 Associated conditions HCV, especially with mucosal involvement of lichen planus Epidemiology Affects women > men 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 Complications < 5% of cases of oral lesions progress to squamous cell carcinoma Prognosis Course is variable and unpredictable