Lichen Planus

Lichen planus is a papular pruritic skin eruption characterized by its violaceous color and polygonal shape. Most frequently, flat-topped papules and plaques are found on the flexor surfaces of the upper extremities, on the genitalia, around the ankles, and on the mucous membranes (Figs. 33-27 and 33-28). Lesions can be intensely pruritic. Because lichen planus is thought to be immune-mediated, it may be

Figure 33-27 Lichen planus with linear papules. © Richard P. Usatine.)
Figure 33-28 Lichen planus on lateral ankle. © Richard P. Usatine.)

found in conjunction with ulcerative colitis, vitiligo, myasthenia gravis, dermatomyositis, and alopecia areata. Lichen planus is also associated with primary biliary cirrhosis, chronic active hepatitis, and hepatitis C infection.

Patients with lichen planus are usually between 30 and 60 years old, although the disorder may occur at any age. Men and women are equally affected, and there is no racial predisposition. The cutaneous form spontaneously resolves within 6 months in about half of patients, and most forms resolve within 18 months. Mucous membrane lesions may become chronic and persist for years. Mild cases can be treated symptomatically with antihistamines and topical steroids. More severe cases or those involving the mucous membranes can be treated with systemic steroids, oral acitretin, or UV light. Other immunosuppressants, such as mycophenolate mofetil and cyclosporine, have also been used with some success.

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