Lichen planus - Revision history

Danbot: Add peer-reviewed reference

2026-03-22T10:16:39Z

Add peer-reviewed reference

← Older revision		Revision as of 10:16, 22 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	*Uncommon disorder of unknown cause, likely T-cell mediated autoimmunity against basal kertinocytes		*Uncommon disorder of unknown cause, likely T-cell mediated autoimmunity against basal kertinocytes<ref>Le Cleach L, Chosidow O. Clinical practice. Lichen planus. N Engl J Med. 2012;366(8):723-732. PMID 22356325</ref>
	*Most common in patients aged 30 to 60 years		*Most common in patients aged 30 to 60 years
	*HCV association is controversial		*HCV association is controversial

Rossdonaldson1: /* External Links */

2023-03-29T21:06:01Z

External Links

← Older revision		Revision as of 21:06, 29 March 2023
Line 155:		Line 155:
	*Squamous cell carcinoma risk is unclear (highest risk with erythematous or erosive oral and genital lichen planus)		*Squamous cell carcinoma risk is unclear (highest risk with erythematous or erosive oral and genital lichen planus)
	Monitor for medication adverse effects		Monitor for medication adverse effects

			==See Also==

	==External Links==		==External Links==

Rossdonaldson1: /* Differential diagnosis */

2023-03-29T21:05:15Z

Differential diagnosis

← Older revision		Revision as of 21:05, 29 March 2023
Line 90:		Line 90:
	*Oral [[candidiasis]]		*Oral [[candidiasis]]
	*[[Pemphigus vulgaris]], benign mucous membrane pemphigoid		*[[Pemphigus vulgaris]], benign mucous membrane pemphigoid
	*Lichenoid drug eruption		*Lichenoid [[drug eruption]]
	**Antimicrobials: aminosalicylate sodium, ethambutol, griseofulvin, ketoconazole, streptomycin, tetracycline, trovafloxacin, isoniazid		**Antimicrobials: aminosalicylate sodium, ethambutol, griseofulvin, ketoconazole, streptomycin, tetracycline, trovafloxacin, isoniazid
	**Antihistamines: ranitidine, roxatidine		**Antihistamines: ranitidine, roxatidine

Rossdonaldson1: /* Differential diagnosis */

2023-03-29T20:59:16Z

Differential diagnosis

← Older revision		Revision as of 20:59, 29 March 2023
Line 104:		Line 104:
	**TNF-alpha antagonists: infliximab, adalimumab, etanercept, lenercept		**TNF-alpha antagonists: infliximab, adalimumab, etanercept, lenercept
	**Varia: allopurinol, bleomycin, cinnarizine, cyanamide, dapsone, hydroxyurea, hepatitis B-vaccine, imatinib, immunoglobulins, interferon alfa, l-thyroxin, levamisole, mesalamine, methycran, penicillamine, procainamide, pyrimethamine, pyrithioxine, quinacrine, sildenafil, sulfasalazine, terbinafine, trihexyphenidyl, ursodeoxycholic acid		**Varia: allopurinol, bleomycin, cinnarizine, cyanamide, dapsone, hydroxyurea, hepatitis B-vaccine, imatinib, immunoglobulins, interferon alfa, l-thyroxin, levamisole, mesalamine, methycran, penicillamine, procainamide, pyrimethamine, pyrithioxine, quinacrine, sildenafil, sulfasalazine, terbinafine, trihexyphenidyl, ursodeoxycholic acid

			{{Plaques DDX}}

	==Diagnosis==		==Diagnosis==

ClaireLewis at 17:24, 25 October 2020

2020-10-25T17:24:24Z

← Older revision		Revision as of 17:24, 25 October 2020
Line 158:		Line 158:
	==References==		==References==
	*Goldstein, BG, Goldstein, AO, Mostow, E. Lichen planus. In: UpToDate, Dellavalle, RP, Callen, J (Ed), UpToDate, Waltham, MA, 2017.		*Goldstein, BG, Goldstein, AO, Mostow, E. Lichen planus. In: UpToDate, Dellavalle, RP, Callen, J (Ed), UpToDate, Waltham, MA, 2017.
			[[Category:Dermatology]]

ClaireLewis at 14:58, 8 September 2019

2019-09-08T14:58:52Z

Show changes

ClaireLewis: Undo revision 181995 by Parkerch (talk)

2019-08-17T17:20:49Z

Undo revision 181995 by Parkerch (talk)

Show changes

Parkerch: Blanked the page

2018-06-17T15:52:58Z

Blanked the page

Show changes

Parkerch at 18:48, 24 September 2017

2017-09-24T18:48:00Z

← Older revision		Revision as of 18:48, 24 September 2017
Line 36:		Line 36:
	*Violaceous plaques with central clearing		*Violaceous plaques with central clearing
	*Common sites are penis, scrotum, and intertriginous areas		*Common sites are penis, scrotum, and intertriginous areas
	~~====Linear lichen planus====~~
	*Isolated linear lesions or zosteriform lesion
	*Koebner effect
	====Bullous lichen planus====		====Bullous lichen planus====
	*Vesicles or bullae within existing lesions		*Vesicles or bullae within existing lesions
Line 140:		Line 137:
	====Histologic Findings====		====Histologic Findings====
	*Pathologic findings seen in lichen planus		*Pathologic findings seen in lichen planus
	**Hyperkeratosis ~~without parakeratosis~~		**Hyperkeratosis with
			**Vacuolization of basal layer with increased melanin
			**Hypergranulosis with irregular widening/elongation of rete ridges
	**Apoptotic keratinocytes in lower epidermis (Civatte bodies) and papillary dermis (eosinophilic colloid bodies)		**Apoptotic keratinocytes in lower epidermis (Civatte bodies) and papillary dermis (eosinophilic colloid bodies)
	**~~Wedge-shaped hypergranulosis~~		**Formation of small clefts with lymphocytic infiltrate at dermal-epidermal junction
	**Bandlike infiltrate of lymphocytic ~~and histiocytic cells~~
	**Linear or shaggy deposits of fibrin and fibrinogen in basement membrane
	====Dermoscopy====		====Dermoscopy====
	*Wickham’s striae		*Wickham’s striae
Line 195:		Line 192:

	==References==		==References==
			*Goldstein, BG, Goldstein, AO, Mostow, E. Lichen planus. In: UpToDate, Dellavalle, RP, Callen, J (Ed), UpToDate, Waltham, MA, 2017.

Parkerch at 18:08, 24 September 2017

2017-09-24T18:08:09Z

← Older revision		Revision as of 18:08, 24 September 2017
Line 28:		Line 28:
	====Hypertrophic lichen planus====		====Hypertrophic lichen planus====
	*Intensely pruritic, flat-topped plaques		*Intensely pruritic, flat-topped plaques
	*Common sites are ~~anterior~~ lower legs		*Common sites are extensor surfaces of lower extremities
	*~~Occasionally develops cutaneous squamous cell carcinoma~~		====Atrophic lichen planus====
			*Violaceous, round or oval, atrophic plaques
			*Common sites are legs
			*Often resolution of annular or hypertrophic lesions
	====Annular lichen planus====		====Annular lichen planus====
	*Violaceous plaques with central clearing ~~(central atrophy may occur)~~		*Violaceous plaques with central clearing
	*Common sites are penis, scrotum, and intertriginous areas		*Common sites are penis, scrotum, and intertriginous areas
			====Linear lichen planus====
			*Isolated linear lesions or zosteriform lesion
			*Koebner effect
	====Bullous lichen planus====		====Bullous lichen planus====
	*Vesicles or bullae within existing lesions		*Vesicles or bullae within existing lesions
Line 38:		Line 44:
	====Actinic lichen planus (lichen planus tropicus)====		====Actinic lichen planus (lichen planus tropicus)====
	*Photodistributed eruption of hyperpigmented macules, annular papules, or plaques		*Photodistributed eruption of hyperpigmented macules, annular papules, or plaques
	*Most common in Middle East, India~~, and east Africa~~		*Most common in Africa, Middle East, and India
	====Lichen planus pigmentosus====		====Lichen planus pigmentosus====
	*Gray-brown or dark brown macules or patches		*Gray-brown or dark brown macules or patches
Line 47:		Line 53:
	*Intertriginous sites (e.g., axillae, inguinal creases, inframammary area, limb flexures)		*Intertriginous sites (e.g., axillae, inguinal creases, inframammary area, limb flexures)
	*Hyperpigmentation is common		*Hyperpigmentation is common
	Scales and erosions may be present		*Scales and erosions may be present
	~~====Atrophic lichen planus====~~
	*Violaceous, round or oval, atrophic plaques
	*Common sites are legs
	~~====Lichen planopilaris (follicular lichen planus)====~~
	*Classic site is the scalp
	*May be in other body sites (e.g., Graham-Little-Piccardi-Lasseur syndrome)
	====Overlap syndromes====		====Overlap syndromes====
	*Lichen planus pemphigoides		*Lichen planus pemphigoides
Line 60:		Line 60:
	*Nail lichen planus [[File:Lehman, 2009 Fig11.tiff\|thumb\|Lichen planus involving the nails]]		*Nail lichen planus [[File:Lehman, 2009 Fig11.tiff\|thumb\|Lichen planus involving the nails]]
	**Varies from minor atrophy to total nail loss		**Varies from minor atrophy to total nail loss
	*Lichen planopilaris		*Lichen planopilaris (follicular lichen planus)
	**~~Occurs on~~ the scalp ~~causing hair loss with keratotic follicular papules~~		**Keratotic papules that may coalesce into plaques
			**Classic site is the scalp
			**May be in other body sites (e.g., Graham-Little-Piccardi-Lasseur syndrome)
	**Untreated, can result in scarring and permanent alopecia		**Untreated, can result in scarring and permanent alopecia
	*Oral lichen planus [[File:Lichen Planus Fig7.tiff\|thumb\|Lichen planus on the lips and the lateral border of the tongue]]		*Oral lichen planus [[File:Lichen Planus Fig7.tiff\|thumb\|Lichen planus on the lips and the lateral border of the tongue]]
Line 80:		Line 82:
	==Differential diagnosis==		==Differential diagnosis==
	The differential diagnosis for lichen planus includes:		The differential diagnosis for lichen planus includes:
			*Chronic graft-versus-host disease
			*Psoriasis
			*Atopic dermatitis
			*Lichen simplex chronicus
			*Subacute cutaneous lupus erythematosus
			*Discoid lupus erythematosus
			*Pityriasis rosea
			*Secondary syphilis
			*Prurigo nodularis
			*Paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome (PAMS)
			*Oral leukoplakia
			*Oral candidiasis
			*Pemphigus vulgaris
			*Benign mucous membrane pemphigoid
	*Lichenoid drug eruption		*Lichenoid drug eruption
	**Antimicrobial substances		**Antimicrobial substances
Line 107:		Line 123:
	**Varia		**Varia
	***Allopurinol, bleomycin, cinnarizine, cyanamide, dapsone, hydroxyurea, hepatitis B-vaccine, imatinib, immunoglobulins, interferon alfa, l-thyroxin, levamisole, mesalamine, methycran, penicillamine, procainamide, pyrimethamine, pyrithioxine, quinacrine, sildenafil, sulfasalazine, terbinafine, trihexyphenidyl, ursodeoxycholic acid		***Allopurinol, bleomycin, cinnarizine, cyanamide, dapsone, hydroxyurea, hepatitis B-vaccine, imatinib, immunoglobulins, interferon alfa, l-thyroxin, levamisole, mesalamine, methycran, penicillamine, procainamide, pyrimethamine, pyrithioxine, quinacrine, sildenafil, sulfasalazine, terbinafine, trihexyphenidyl, ursodeoxycholic acid
	*Chronic graft-versus-host disease
	*Psoriasis
	*Atopic dermatitis
	*Lichen simplex chronicus
	*Subacute cutaneous lupus erythematosus
	*Discoid lupus erythematosus
	*Pityriasis rosea
	*Secondary syphilis
	*Prurigo nodularis
	*Paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome (PAMS)
	*Oral leukoplakia
	*Oral candidiasis
	*Pemphigus vulgaris
	*Benign mucous membrane pemphigoid

	==Diagnosis==		==Diagnosis==
	*Often clinical diagnosis		Often clinical diagnosis
	====Questions to ask====		===Questions to ask===
	*Current medications		*Current medications
	*Pruritus		*Pruritus
Line 130:		Line 132:
	*Dysphagia or odynophagia		*Dysphagia or odynophagia
	*Risk factors for HCV		*Risk factors for HCV
	====Physical exam====		===Physical exam===
	*Expose and examine all cutaneous surfaces		*Expose and examine all cutaneous surfaces
	====Biopsy ~~(e.g., punch biopsy, shave biopsy)~~====		===Workup===
			====Biopsy====
			*Punch biopsy or shave biopsy
	*Immunofluorescence studies if bullous lesions present		*Immunofluorescence studies if bullous lesions present
	====~~Dermoscopy~~====		====Histologic Findings====
	*Wickham’s striae
	~~====HCV testing====~~
	*Routine testing controversial
	~~==Histopathology~~==
	*Pathologic findings seen in lichen planus		*Pathologic findings seen in lichen planus
	**Hyperkeratosis without parakeratosis		**Hyperkeratosis without parakeratosis
Line 145:		Line 145:
	**Bandlike infiltrate of lymphocytic and histiocytic cells		**Bandlike infiltrate of lymphocytic and histiocytic cells
	**Linear or shaggy deposits of fibrin and fibrinogen in basement membrane		**Linear or shaggy deposits of fibrin and fibrinogen in basement membrane
			====Dermoscopy====
			*Wickham’s striae
			====HCV testing====
			*Routine testing controversial

	==Managment==		==Managment==
	====Cutaneous====		====Cutaneous====
			Self-limiting disease, usually resolves within 8-12 months
	*First-line		*First-line
	**[[Topical corticosteroid]]		**[[Topical corticosteroid]]
Line 185:		Line 190:
	*More persistent and resistant to therapy		*More persistent and resistant to therapy
	*Squamous cell carcinoma risk is unclear (highest risk with erythematous or erosive oral and genital lichen planus)		*Squamous cell carcinoma risk is unclear (highest risk with erythematous or erosive oral and genital lichen planus)
			Monitor for medication adverse effects

	==External Links==		==External Links==

	==References==		==References==