Lichen Planus

Background

• Lichen planus is an autoimmune inflammatory skin condition that can also affect the scalp, nails, oral mucosa, and/or genital mucosa.
• It typically presents in middle-aged patients. Skin lesions generally resolve within 1-2 years, although mucosal lesions are usually recurrent and chronic.
• Malignant transformation may occur at mucosal sites but the risk is low.

Evaluation

• Cutaneous lesions are most commonly violaceous, or pink, pruritic papules on flexor surfaces. Mucosal lesions may be vesicular, plaque-like, resembling leukoplakia, or painful, erosive ulcers.
• Consider similar-appearing skin disorders, such as lichenoid drug reactions, contact dermatitis, psoriasis, candidiasis, syphilis and vesiculobullous disorders.
• Diagnosis can be made clinically, but biopsy should be obtained for oral lesions and for lesions refractory to initial treatment to confirm diagnosis and rule out dysplastic lesions.
• Consider testing for hepatitis C antibody, since hepatitis C may be associated with lichen planus.

Management

• Consider treatment aimed at controlling symptoms until lesions resolve.
• Consider a high-potency topical corticosteroid for cutaneous, oral, or genital lesions, such as clobetasol propionate 0.05% ointment.
• Consider intralesional triamcinolone acetonide 5-10 mg/mL injection monthly for first-line option for nail lichen planus if ≥ 3 nails affected or for lichen planopilaris
• For more severe cutaneous lesions, or for painful, erosive mucosal lesions, consider oral prednisone 0.5-1 mg/kg/day for 4-6 weeks. Other options include nonsteroidal immunosuppressants, phototherapy, and laser treatment.