Cutaneous Lichen Planus

Aka: Cutaneous Lichen Planus, Lichen Planus

II. Epidemiology

  1. Prevalence: 0.1-4% in United States
  2. Age usually 30-60 years
  3. Gender predominance: Slightly more common in women (especilly Perimenopause)

III. Pathophysiology

  1. Autoimmune mediated apoptosis of epithelial cells
  2. Involves CD8+ Cytotoxic T-Cells

IV. Associated Conditions

  1. Hepatitis C

V. Signs: General

  1. Characteristics
    1. Classic 6Ps
      1. Planar (flat topped lesions)
      2. Purple
      3. Polygonal
      4. Pruritic
      5. Papules
      6. Plaques
    2. Wickham Striae
      1. Lacy, reticular white lines covering the lesions
    3. Koebner Phenomenon
      1. May form in lines related to scratching
    4. Postinflammatory Hyperpigmentation
      1. May occur with lesion resolution (especially in dark skin)
  2. Distribution
    1. Cutaneous lesions form on flexor surfaces of wrists, Forearms, legs
    2. Oral Lichen Planus (25%)
    3. Genitalia
      1. Glans penis with annular pattern (see below)
      2. Vulvar Lichen Planus
    4. Scalp Lichen Planus
      1. Scaly pruritic Papules
      2. May progress to scarring Alopecia
    5. Nail Lichen Planus
      1. Irregular longitudinal grooves or ridges in the nail plate
      2. Subungual keratosis or Hyperpigmentation

VI. Types: Variants

  1. Annular Lichen Planus (10%)
    1. See Annular Lesions
    2. Rings of clustered lesions with central clearing
    3. May also form on penis and Buccal mucosa
  2. Atrophic Lichen Planus (rare)
    1. Patches or Plaques with superficial atrophy of variable coloration
  3. Hypertrophic Lichen Planus
    1. Forms on extensor surfaces (ankles, shins, PIP and DIP joint)
    2. Very pruritic
    3. Chronic with prominent scarring
  4. Vesiculobullous Lichen Planus
    1. Classic Lichen Planus lesions form bullae or vessicles
    2. Typically on mouth, back, buttocks, or legs

VII. Diagnosis

  1. Classic polygonal lesions on the flexor surfaces may not require biopsy for diagnosis
  2. Biopsy findings
    1. Epidermal hyperplasia with saw pattern
    2. Hyperparakeratosis with granular cell layer thickening
    3. Basal layer with vacuolar alteration
    4. T-Cell infiltration of the dermal-epidermal junction

VIII. Differential Diagnosis

  1. Eczema
  2. Lichen Simplex Chronicus
  3. Prurigo nodularis
  4. Psoriasis
  5. Variants
    1. See Annular Lesion
    2. See Vesiculobullous

IX. Evaluation

  1. Liver Function Tests
  2. Hepatitis C Antibody

X. Management: Cutaneous Lichen Planus

  1. See Oral Lichen Planus
  2. See Vulvar Lichen Planus
  3. See Pruritus Management
  4. Cutaneous Lichen Planus (non-genital)
    1. High potency Topical Corticosteroids
  5. Severe, diffuse Cutaneous Lichen Planus
    1. Prednisone 30-60 mg orall daily for 3-6 weeks and then taper over an additional 4-6 weeks
    2. Phototherapy for 30-40 minutes each of 2-3 days per week

XI. References

  1. Usatine (2011) Am Fam Physician 84(1):53-60 [PubMed]

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Related Studies

Ontology: Lichen Planus (C0023646)

Definition (NCI) A chronic, recurrent, pruritic inflammatory disorder of unknown etiology that affects the skin and mucus membranes. It presents with rashes and papules that tend to resolve spontaneously. It may be associated with hepatitis C. Certain drugs that contain arsenic or bismuth are associated with reactions mimicking lichen planus.
Definition (MSH) An inflammatory, pruritic disease of the skin and mucous membranes, which can be either generalized or localized. It is characterized by distinctive purplish, flat-topped papules having a predilection for the trunk and flexor surfaces. The lesions may be discrete or coalesce to form plaques. Histologically, there is a "saw-tooth" pattern of epidermal hyperplasia and vacuolar alteration of the basal layer of the epidermis along with an intense upper dermal inflammatory infiltrate composed predominantly of T-cells. Etiology is unknown.
Definition (CSP) inflammatory, pruritic disease of the skin and mucous membranes, which can be either generalized or localized; characterized by distinctive purplish, flat-topped papules having a predilection for the trunk and flexor surfaces; lesions may be discrete or coalesce to form plaques.
Concepts Disease or Syndrome (T047)
MSH D008010
ICD9 697.0
ICD10 L43 , L43.9
SnomedCT 156377007, 201004002, 4776004
French LICHEN PLAN, Lichen plan
English Lichen Rubra Planus, Lichen Ruber Planus, LICHEN PLANUS, Lichen planus NOS, Lichen planus, unspecified, Lichen Planus, lichen ruber planus, lichen planus (diagnosis), lichen planus, Lichen Planus [Disease/Finding], Lichen planus NOS (disorder), Lichen planus, Ruber planus, LP - Lichen planus, Lichen planus (disorder), Wilson; lichen ruber, lichen ruber; Wilson, lichen; planus, of Wilson, lichen; planus, lichen; ruber planus, planus; lichen ruber planus, planus; lichen, of Wilson, planus; lichen, ruber; lichen ruber planus, Lichen, ruber planus
Portuguese LIQUEN PLANO, Líquen plano, Líquen Plano, Líquen Plano Rubro
Spanish LIQUEN PLANO, liquen plano, SAI, liquen plano, SAI (trastorno), liquen plano (trastorno), liquen plano, Liquen plano, Liquen Plano, Liquen Rojo Plano
German LICHEN PLANUS, Lichen ruber planus, nicht naeher bezeichnet, Lichen planus, Lichen ruber planus
Swedish Lichen planus
Japanese ﾍﾝﾍﾟｲﾀｲｾﾝ, 苔癬-扁平, 紅色苔癬, 扁平紅色苔癬, 扁平苔癬, 苔癬-扁平紅色
Czech lichen ruber planus, lichen planus, Lichen planus
Finnish Punajäkälä
Russian LIKHEN PLOSKII, KRASNYI PLOSKII LISHAI, LISHAI PLOSKII, КРАСНЫЙ ПЛОСКИЙ ЛИШАЙ, ЛИХЕН ПЛОСКИЙ, ЛИШАЙ ПЛОСКИЙ
Italian Lichen ruber planus, Lichen planus
Korean 편평태선, 상세불명의 편평태선
Croatian LICHEN PLANUS
Polish Liszaj płaski, Liszaj czerwony płaski
Hungarian Lichen planus
Norwegian Lichen ruber planus, Lichen planus
Dutch Wilson; lichen ruber, lichen ruber; Wilson, lichen; planus, van Wilson, lichen; planus, lichen; ruber planus, planus; lichen ruber planus, planus; lichen, van Wilson, planus; lichen, ruber; lichen ruber planus, Lichen planus, niet gespecificeerd, lichen planus, Lichen planus, Lichen ruber planus
Derived from the NIH UMLS (Unified Medical Language System)

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