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CME

Lichen Planus

General Information

Description

  • autoimmune, papulosquamous disorder affecting skin, scalp, nails, oral mucosa, and/or genital mucosa1,2,3,6

Types

  • lichen planus usually categorized by site of involvement and lesion morphology, but patients may have more than one subtype and more than one site of involvement1,2,3,6
    • sites of involvement may include
      • cutaneous lichen planus (including nails, scalp)
      • oral lichen planus
      • genital or vulvar lichen planus
      • other, rare sites include ocular, esophageal, and laryngeal
    • cutaneous subtypes include
      • papular (also called classic)
        • characterized by violaceous, flat-topped papule
        • may be covered by whitish points or lacy lines (called Wickham striae), often seen on the buccal mucosa
        • seen on flexor surfaces
      • hypertrophic
        • characterized by hyperkeratotic, plaques, usually on extremities, in symmetrical distribution
        • pruritic
      • vesiculobullous
        • characterized by blisters on plaques
        • usually on lower extremities
      • actinic
        • characterized by nummular patches or plaques with hyperpigmented center and hypopigmented halo
        • rare
        • more common in African Americans, Indians, Middle Easterners
        • seen on sun-exposed areas
      • annular
        • seen most often in male genitalia, axilla, groin, extremities
        • may be pruritic, or asymptomatic
      • atrophic
        • considered last stage of chronic annular or hypertrophic lichen planus
        • may develop after long-term topical steroid use on lichen planus lesions
      • linear
        • characterized by linear lesions, often on lower extremities
        • may be due to Koebner phenomenon (lesions develop after trauma to skin and in distribution of trauma, for example after scratching)
      • erosive
        • characterized by ulcerative lesions
        • may be seen on soles of feet
      • follicular (including planopilaris)
        • characterized by hyperkeratotic papules, most commonly seen on scalp
        • may lead to alopecia
        • more common in women than men
      • lichen planus pigmentosus
        • more common in darker skinned persons
        • lesions in sun-exposed areas and bilateral
      • lichen planus pigmentosus inversus
        • more common in lighter-skinned persons than darker
        • seen in intertriginous and flexural sites
      • lichen planus pemphigoides
      • lichen planus-lupus erythematosus overlap
    • oral subtypes include2,3,4
      • reticular
        • most common
        • usually asymptomatic
        • seen as lacy, white streaks with erythematous borders
        • may be triggered by Koebner phenomenon
        • more commonly seen on buccal mucosa, lateral and dorsal tongue, gingiva, lips
      • plaque-like
        • characterized by large, white patches
        • must be distinguished from leukoplakia
        • more common in smokers
        • associated with poor prognosis of lichen planus (LP)
      • papular
        • characterized by small, white papules
        • asymptomatic
        • may be initial stage of other lesions
      • erosive
        • ulcerations of mucosa that may appear erythematous or atrophic
        • may have white striae or pseudomembrane covering
        • often painful
        • considered an advanced form of LP
      • atrophic
        • characterized by atrophic lesions with erythematous background
        • similar to erosive lesions
        • seen mostly on gingiva and buccal mucosa
        • may be more common in older patients
      • bullous
        • rare in oral LP
    • anogenital and vulvar lichen planus subtypes include6,4
      • erosive
        • most common vulvovaginal lesion
        • eroded areas, sometimes with Wickham striae
        • associated with bleeding, pain, serosanguinous discharge
        • may lead to scarring and synechia
      • classical, also called papulosquamous
        • characterized by pruritic, violaceous or pink papules
        • may appear on perianal skin
      • hypertrophic
        • thickened, warty growths, in perineum and perianal area
        • may become infected, ulcerated, and painful
        • may look like squamous cell carcinoma, vulvar intraepithelial neoplasia, or lichen sclerosus

References

General references used

  1. Usatine RP, Tinitigan M. Diagnosis and treatment of lichen planus. Am Fam Physician. 2011 Jul 1;84(1):53-60full-text
  2. Carrozzo M, Thorpe R. Oral lichen planus: a review. Minerva Stomatol. 2009 Oct;58(10):519-37full-text [English, Italian]
  3. Canto AM, Müller H, Freitas RR, Santos PS. Oral lichen planus (OLP): clinical and complementary diagnosis. An Bras Dermatol. 2010 Oct;85(5):669-75full-text
  4. Gorouhi F, Davari P, Fazel N. Cutaneous and Mucosal Lichen Planus: A Comprehensive Review of Clinical Subtypes, Risk Factors, Diagnosis, and Prognosis. ScientificWorldJournal. 2014;2014:742826full-text
  5. Le Cleach L, Chosidow O. Clinical practice. Lichen planus. N Engl J Med. 2012 Feb 23;366(8):723-32
  6. Fruchter R, Melnick L, Pomeranz MK. Lichenoid vulvar disease: A review. Int J Womens Dermatol. 2017 Mar;3(1):58-64full-text

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  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T116470, Lichen Planus; [updated 2018 Dec 03, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T116470. Registration and login required.

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