Lichen Planus: By David Robles, MD, PhD

Lichen planus is an inflammatory skin disease of unknown cause. It is NOT contagious. It is characterized by smooth, flat-topped, firm papules that are purplish in color and have distinctive fine white lines (called ‘Wickham's striae’).

The most frequently involved sites are the flexor surfaces of the wrists and forearms; the back of the hands, lower legs and ankles. 

Linear papules may occur at sites of previous trauma or scratching, a phenomenon known has koebnerization.

Lesions may occur on the oral mucosa in up to 30-50% of patients, and may sometimes be the only site of involvement. 

Lichen planus of the mouth most commonly affects the inside of the cheeks, gums and tongue. 

Oral Lichen planus may have no symptoms at all or may cause painful sores and ulcers. Lesions may also occur on the glans penis in males. In females, some patients with this condition may have erosive, painful lesions in the vaginal area. 

Nail findings are found in roughly 10% of patients with lichen planus. These findings are most commonly longitudinal grooving and ridging, splitting, nail thinning and nail loss.

Lichen planus on the scalp is called, lichen planopilaris. This form of hair loss (alopecia) is characterized by permanent scarring.

Most cases of skin lichen planus resolve within 2 years.  Unfortunately for some, lichen planus remains a chronic condition and comes and goes for years. Although the exact cause of lichen planus has not been elucidated, it has been associated with multiple environmental exposures, including viral infections and medications. There is no cure for lichen planus, but several treatments options exist including, topical corticosteroids, antihistamines, systemic corticosteroids, and UV light treatment. 

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