Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

906 Lichen Planus

tests

Blood Tests

■Possibly patients should be tested for hepatitis C infection

Other Tests

■Skin biopsy often shows “wedge-like hypergranulosis,” “sawtooth

of rete ridges,” hyperkeratosis, vacuolization of basal cell layer, and

dense bandlike infiltrate that obscures DE junction

differential diagnosis

■Lichenoid drug eruption – history of an associated drug

■Pytiriasis rosea – herald patch, “Christmas tree” pattern

■Psoriasis

■Syphilis – palmar lesions, positive STS

■Scalp lesions

➣lupus erythematosus – typical lesions elsewhere

➣folliculitis decalvans – pustular lesions

■Hypertrophic lesions – warts, hypertrophic lupus erythematosus,

squamous cell carcinoma

■Oral lesions – lupus erythematosus, leukoplakia, squamous cell car-

cinoma

management

n/a

specific therapy

■Limited lesions, treat with super-potent topical corticosteroid or

intralesional corticosteroids

■If widespread, may use:

➣systemic corticosteroids

➣PUVA

➣Isotretinoin or acitretin

➣Cyclosporine, azathioprine, mycophenolate mofetil may be used

for severe cases.

follow-up

n/a

complications and prognosis

■Reported risk of oral SCC in oral and genital lesions

■Variable outcomes: 2/3 of pts have LP <1 yr, most clear in 2nd year

➣Recurrence in half of patients

➣Some may require long-term follow-up.