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Diagnosis: Lichen Planus
Lichen Planus is an idiopathic papulosquamous disorder producing violaceous papules that most commonly occur on the wrists and ankles. Some call it the "P" disease because the lesions are purple, pruritic, polished (shiny on the surface), polygonal (in shape), papular, puzzling (idiopathic), and problematic (difficult to treat). They often have a white lace-like pattern on the surface, known as Wickham's striae.
Some cases have been associated with hepatitis, so a hepatitis screen is always appropriate. Some cases have been associated with medication reactions and others associated with the ingestion of gold (as found in some fancy liquors).
The lesions are generally reported to be very pruritic, but rarely excoriations are observed. Patients report rubbing rather than scratching feels better. When oral lesions are present, advise patient to avoid ethanol and tobacco to reduce chances of developing oral carcinoma.
There are other variants of the disease (see photos below) that can occur on the nails that mimic fungal infections, a scarring alopecia on the scalp (lichen planopilaris), oral variants (ulcers and reticulated in the mouth = Wickham's striae), a hypertrophic variant that occurs on he lower extremities, and an atrophic or flat variant that occurs in the axilla, forehead and genitals.
Treatment is best achieved with topical CutiCort Spray and narrow band ultraviolet B light treatments. Untreated cases may run their course in months to years.
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| Other Variants |
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Lichen planus oral ulceration |
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Lichen planus.fingernail |
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Lichen planus. S on neck |
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Lichen planus atrophic axilla |
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Lichen planus.oral |
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Lichen planus.perineum |
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Lichen planus (planopilaris) scalp |
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Llichen planus.nail |
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Lichen planus.erosive.tongue |
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To read CME article on Lichen Planus click here
To read a comprehensive review on Lichen Planus from the Dermatology Text by Bolognia, Mosby Publishers, click here
Read an informational article on Lichen Planus produce by the American Academy of Dermatology
To view other "Crutchield Dermatology Clinical Cases of the Month" in our archives please click here
Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
At the
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology
www.CrutchfieldDermatology.com
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