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General Medicine

Lichen Planus

Reviewed 06/2020
 


BASICS

Lichen planus (LP) is an idiopathic eruption with characteristic shiny, flat-topped (Latin: planus, “flat”) purple (violaceous) papules and plaques on the skin, often accompanied by characteris...

DIAGNOSIS

LP is most commonly diagnosed by its appearance despite its range of clinical presentations. A skin biopsy should be performed if the diagnosis is in doubt. 

HISTORY

A minority of patients hav...

TREATMENT

Although LP can resolve spontaneously, treatment is usually requested by patients who may be severely symptomatic or troubled by its cosmetic appearance. 

GENERAL MEASURES

  • Goal is to relieve i...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Serial oral examinations for erosive/ulcerative lesions 

PATIENT EDUCATION

  • Oral, erosive, or ulcerative LP: annual follow-up to screen for maligna...

REFERENCES

1
Shengyuan L, Songpo Y, Wen W, et al. Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis. Arch Dermatol.  2009;145(9):1040–1047.
2
Arias-Santiago...

ADDITIONAL READING

  • Fazel N. Cutaneous lichen planus: a systematic review of treatments. J Dermatolog Treat.  2015;26(3):280–283.

  • Kolios AG, Marques Maggio E, Gubler C, et al. Oral, esophageal and ...

CODES

ICD10

  • L43.9 Lichen planus, unspecified

  • L43.0 Hypertrophic lichen planus

  • L43.1 Bullous lichen planus

  • L43.8 Other lichen planus

ICD9

697.0 Lichen planus 

SNOMED

  • 4776004 Lichen planus (disorder)

  • 68266006 Hy...

CLINICAL PEARLS

  • Remember the 7 P’s of LP: purple, planar, polygonal, polymorphic, pruritic (not always), papules that heal with postinflammatory hyperpigmentation

  • Serial oral or genital exams are indic...

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Related Images
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Lichen planus. The Köbner phenomenon (isomorphic response) results from scratching. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.
Lichen planus. The Köbner phenomenon (isomorphic response) results from scratching. From Goodheart HP. Goodheart's Photoguide to Common Ski...
Lichen planus. Oral lesions, with a white, lacy, reticulated, pattern on the buccal mucosa. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.
Lichen planus. Oral lesions, with a white, lacy, reticulated, pattern on the buccal mucosa. From Goodheart HP. Goodheart's Photoguide to Co...
Lichen planus. Typical flat-topped papules are noted on the glans and the distal shaft of this patient's penis (compare to psoriasis of penis in Figure 4.24). From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.
Lichen planus. Typical flat-topped papules are noted on the glans and the distal shaft of this patient's penis (compare to psoriasis of pen...
Lichen planus, hypertrophic. Darkly pigmented hypertrophic lesions are present on the pretibial shaft. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.
Lichen planus, hypertrophic. Darkly pigmented hypertrophic lesions are present on the pretibial shaft. From Goodheart HP. Goodheart's Photo...
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