An idiopathic inflammatory disease affecting the skin, hair, nails, and mucous membranes, usually self-limiting in nature.
Characteristic eruption consists of itchy, shiny, flat-topped violaceous papules and plaques favouring the extremities.
White net-like patches or ulceration of mucous membranes, nail deformity, scarring alopecia, and other types of skin lesions may also occur.
Most patients develop the disease between the age of 30 and 60 years.
Hepatitis C infection may increase susceptibility, especially to oral disease.
Treatment may involve corticosteroids, retinoids, calcineurin inhibitors, immunosuppressants, and phototherapy.
History and exam
Key diagnostic factors
- violaceous, flat-topped papules or plaques
- Wickham's striae
- mucosal erosions and lacy white network
- scarring alopecia
- nail involvement
Other diagnostic factors
- dorsal pterygium
- history of hepatitis C (HCV)
- hepatitis C (in some patient populations)
- -308 G/A polymorphism in TNF-alpha gene
- hepatitis B vaccination
- influenza vaccination
- psychosocial stress
- oral allergens
1st investigations to order
- clinical diagnosis
Investigations to consider
- hepatitis C (HCV) screen
- Lichen simplex chronicus
- Lichen planus pemphigoides
- 2014 UK national guideline on the management of vulval conditions
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer