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Lichen planus

Last reviewed: 4 Sep 2023
Last updated: 08 Apr 2020



History and exam

Key diagnostic factors

  • pruritus
  • violaceous, flat-topped papules or plaques
  • Wickham striae
  • mucosal erosions and lacy white network
  • scarring alopecia
  • nail involvement
More key diagnostic factors

Other diagnostic factors

  • dorsal pterygium
  • history of hepatitis C (HCV)
Other diagnostic factors

Risk factors

  • hepatitis C (in some patient populations)
  • -308 G/A polymorphism in TNF-alpha gene
  • hepatitis B vaccination
  • influenza vaccination
  • psychosocial stress
  • oral allergens
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • histopathology
  • hepatitis C screen
  • immunofluorescence
More investigations to consider

Treatment algorithm


cutaneous disease

scalp disease

oral disease

genital disease

nail disease



Susan Cooper, MBChB (Bristol), MRCGP, FRCP

Consultant Dermatologist


Oxford University Hospitals Foundation Trust

Honorary Senior Clinical Lecturer

University of Oxford




SC is chair of the British Society for the Study of Vulval Disease and receives royalties for contributions to UpToDate.

Deepani Munidasa, MBBS, MD

Consultant Dermatologist

Department of Dermatology

Anuradhapura Teaching Hospital


Sri Lanka


DM declares that she has no competing interests.


Dr Susan Cooper and Dr Deepani Munidasa would like to gratefully acknowledge Dr Rebecca Dunn, Dr Julia S. Lehman, Dr Megha M. Tollefson, and Dr Lawrence E. Gibson, previous contributors to this topic. RD, JSL, MMT, and LEG declare that they have no competing interests.

Peer reviewers

Brian Swick, MD

Clinical Assistant Professor

University of Iowa College of Medicine

Iowa City



BS declares that he has no competing interests.

David Cassarino, MD, PhD

Assistant Professor

Department of Pathology and Laboratory Medicine

University of California

Los Angeles



DC declares that he has no competing interests.

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