Internal Medicine

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

Lichen Planus 905

LICHEN PLANUS

MARK WALDMAN, MD and JEFFREY P. CALLEN, MD

REVISED BY JEFFREY P. CALLEN, MD

history & physical

History

■Common pruritic inflammatory disease of skin, hair follicles, and

mucous membranes

■All races affected

■Occurs in males 20–60 years old

■Occurs in females at increasing rate with increasing age, with peak

in 60s

Classification

■Classical lichen planus

■Oral lichen planus – may occur in the absence of cutaneous involve-

ment or in conjunction with it. May be accompanied by disease of

other mucous membranes (e.g., vulvo-vaginal).

■Genital lichen planus (frequently pt has accompanying oral disease)

■Inverse lichen planus – intertriginous involvement

■Hypertrophic lichen planus verrucous lesions, often on the legs

■Lichen planopilaris – scarring alopecia

■Lichenoid drug eruption – gold salts, antimalarials, penicillamine

are the most common

Signs & Symptoms

■Classic lesion: violaceous, flat-topped, polygonal papule with glis-

tening surface and scant adherent scale; may also see Wickham’s

striae on surface

■Begin as pinpoint papules and increase to 0.5–1.0 cm plaques

■Predilection for flexor wrists, trunk, medial thighs, dorsal hands and

glans penis

■Pruritus often prominent

■Nail changes in 5–10% patients; may result in permanent nail dys-

trophy

■Mucous membrane frequently affected; seen as reticulated white

patch

■Hypertrophic LP – verrucous lesions most often on the anterior legs