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Lichen planus

Last reviewed: 22 Nov 2024
Last updated: 20 Dec 2024

Summary

Definition

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
Full details

Other diagnostic factors

  • dorsal pterygium
  • history of hepatitis C (HCV)
Full details

Risk factors

  • hepatitis C (in some patient populations)
  • -308 G/A polymorphism in TNF-alpha gene
  • hepatitis B vaccination
  • influenza vaccination
  • coronavirus disease 2019 (COVID-19) vaccination
  • psychosocial stress
  • oral allergens
  • use of certain drugs
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • histopathology
  • hepatitis C screen
  • immunofluorescence
Full details

Treatment algorithm

ACUTE

cutaneous disease

scalp disease

oral disease

genital disease

nail disease

Contributors

Authors

Deepani Munidasa, MBBS, MD

Consultant Dermatologist

Department of Dermatology

Anuradhapura Teaching Hospital

Anuradhapura

Sri Lanka

Disclosures

DM declares that she has no competing interests.

Acknowledgements

Dr Deepani Munidasa would like to gratefully acknowledge Dr Susan Cooper, Dr Rebecca Dunn, Dr Julia S. Lehman, Dr Megha M. Tollefson, and Dr Lawrence E. Gibson, previous contributors to this topic.

Disclosures

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

IA

Disclosures

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

CA

Disclosures

DC declares that he has no competing interests.

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