Lichen planus

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Synonyms and keywords: Ruber planus; Wickham striae

Overview

Lichen planus is an inflammatory disease that affects the skin and the oral mucosa.

Historical Perspective

Classification

Lichen Planopilaris is the specific name given to lichen planus on the scalp that may cause permanent, scarring alopecia. If left untreated the scarring will cause permanent hair loss. The Cicatricial Alopecia Research Foundation is a non-profit organization that provides support and resources for people with lichen planopilaris.

Pathophysiology

Causes

Common Causes

The cause of lichen planus is not known; however, there are cases of lichen planus-type rashes (known as lichenoid reactions) occurring as allergic reactions to medications for high blood pressure, heart disease and arthritis. These lichenoid reactions are referred to as lichenoid mucositis (of the mucosa) or dermatitis (of the skin). Lichen planus has been reported as a complication of chronic hepatitis C virus infection and can be a sign of chronic graft-versus-host disease of the skin. It has been suggested that true lichen planus may respond to stress, where lesions may present on the mucosa or skin during times of stress in those with the disease.

Causes in Alphabetical Order

Differentiating lichen planus from other Diseases

The clinical presentation of lichen planus may also resemble other conditions, including:

A biopsy is useful in identifying histological features that help differentiate lichen planus from these conditions.

Epidemiology and Demographics

Age

Lichen planus in children is rare, and it occurs most often in middle-aged adults.

Gender

Lichen planus affects women more than men (at a ratio of 3:2).

Risk Factors

Some of the risk factors for lichen planus are as follows:

Exposure to medications, dyes, and other chemical substances (including gold, antibiotics, arsenic, iodides, chloroquine, quinacrine, quinide, phenothiazines, and diuretics)
Disorders such as hepatitis C

Natural History, Complications, and Prognosis

Lichen planus is usually not harmful and may get better with treatment. It usually clears up within 18 months. However it may last for weeks to months, and may come and go for years. If lichen planus is caused by a medication, the rash should go away once the medicine is stopped.

A possible complication that is associated with lichen planus is that mouth ulcers that are there for a long time may develop into oral cancer.

Diagnosis

Symptoms

The microscopic appearance of lichen planus is pathognomonic for the condition

Hyperparakeratosis with thickening of the granular cell layer
Development of a "saw-tooth" appearance of the rete pegs
Degeneration of the basal cell layer
Infiltration of inflammatory cells into the subepithelial layer of connective tissue

Other symptoms such as:

Physical Examination

The typical rash of lichen planus is well-described by the "5 P's": well-defined pruritic, planar, purple, polygonal papules. The commonly affected sites are near the wrist and the ankle. The rash tends to heal with prominent blue-black or brownish discoloration that persists for a long time. Besides the typical lesions, many morphological varieties of the rash may occur. The presence of cutaneous lesions is not constant and may wax and wane over time. Oral lesions tend to last far longer than cutaneous lichen planus lesions.

The following images show good examples of how lichen planus manifests on the body.

Lichen planus close up
Lichen planus on the arm
Lichen planus on the oral mucosa
Lichen planus on the hands

Skin

Lichen Planus Actinicus

Face

Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]

Trunk

Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]

Extremity

Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]

Lichen planus annular

Trunk

Lichen planus annular. Adapted from Dermatology Atlas.^[1]
Lichen planus annular. Adapted from Dermatology Atlas.^[1]

Lichen Planus Follicularis

Neck

Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]

Extremity

Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]

Scalp

Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]

Lichen Planus Linearis

Trunk

Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]

Extremity

Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]

Lichen Planus Verrucosus

Lichen planus verrucosus . Adapted from Dermatology Atlas.^[1]
Lichen planus verrucosus . Adapted from Dermatology Atlas.^[1]

Lichen Planus Vesicular

Trunk

Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]

Extremity

Lichen planus vesicular. Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular. Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]

Mucosal Lichen Planus

Oral cavity

Mucosal lichen planus. Adapted from Dermatology Atlas.^[1]
Mucosal lichen planus . Adapted from Dermatology Atlas.^[1]
Mucosal lichen planus . Adapted from Dermatology Atlas.^[1]

Differential diagnosis

Lichen planus must be differentiated from other diseases that cause ust be differentiated from other diseases that cause rash and eczema such as secondary syphilis and pityriasis rosea.

Disease	Rash Characteristics	Signs and Symptoms	Associated Conditions	Images
Cutaneous T cell lymphoma/Mycosis fungoides^[2]	Premycotic phase: A scaly, red rash in areas of the body that usually are not exposed to the sun. This rash does not cause symptoms and may last for months or years. Patch phase: Thin, erythematous, eczema-like rash. Plaque phase: Small raised bumps (papules) or hardened lesions on the skin, which may be erythematous. Tumor phase: Tumors form on the skin. Infection secondary to ulcers.	Epidermal atrophy or poikiloderma Generalized itching (pruritus) Pain in the affected area of the skin Insomnia Red (erythematous) patches scattered over the skin of the trunk and the extremities Tumor-like lobulated outgrowths form on the skin in the latter phase of the disease Weight loss Lymphadenopathy Malaise and fatigue Anemia May progress to Sezary syndrome (skin involvement plus hematogenous dissemination)	Sezary syndrome	By Bobjgalindo - Own work, GFDL, https://commons.wikimedia.org/w/index.php?curid=7139812
Pityriasis rosea^[3]	Pink or salmon in color, which may be scaly; referred to as "herald patch" Oval shape Long axis oriented along the cleavage lines Distributed on the trunk and proximal extremities Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on posterior trunk Secondary to viral infections Resolves spontaneously after 6-8 weeks	Preceded by a prodrome of: Sore throat Gastrointestinal disturbance Fever Arthralgia	Infection by any of the following:^[4] HHV-6 HHV-7 HHV-8	By James Heilman,MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16305230
Pityriasis lichenoides chronica	Recurrent lesions are usually less evenly scattered than in cases of psoriasis Brownish red or orange-brown in color Lesions are capped by a single detachable, opaque, mica-like scale Often leave hypopigmented macules	High fever Malaise Myalgias Paraesthesia Pruritus	Infection by any of the following:^[5] Epstein-Barr virus (EBV) Toxoplasma gondii Human immunodeficiency virus (HIV)
Nummular dermatitis^[6]	Multiple coin-shaped eczematous lesions Commonly affecting the extremities (lower>upper) and trunk May ooze fluid and become dry and crusty	Often appears after a skin injury, such as a burn, abrasion (from friction), or insect bite Lesions commonly relapse after occasional remission or may persist for long periods Pruritus	Associated with: Dry skin Emotional stress Allergens (rubber chemicals, formaldehyde, neomycin, chrome, mercury, and nickel) Staphylococcus infection Seasonal variation Alcohol Drugs Atopy
Secondary syphilis^[7]	Round, coppery, red colored lesions on palms and soles Papules with collarette of scales	Fever Generalized lymphadenopathy Sore throat Patchy hair loss Headache Weight loss Myalgia Fatigue	Associated with: Condylomata lata Corona verinata Positive VDRL test	By James Heilman,MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16305230
Bowen’s disease^[8]	Erythematous, small, scaly plaque, which enlarges erratically over time Scale is usually yellow or white and it is easily detachable without any bleeding Well-defined margins	Pruritus Pain Bleeding lesions	Associated with:^[9] Erythroplasia of Queyrat (Bowen's disease of the penis) Squamous cell carcinoma Solar radiation and ultraviolet (UV) exposure Radiotherapy Immunosuppression Arsenic exposure Human papilloma virus (HPV) type 16 Merkel cell polyomavirus Sjögren’s syndrome	By Klaus D. Peter, Gummersbach, Germany - Own work (own photograph), CC BY 3.0 de, https://commons.wikimedia.org/w/index.php?curid=6839115
Exanthematous pustulosis^[10]	Numerous small, primarily non-follicular, sterile pustules, arising within large areas of edematous erythema	Fever Leukocytosis Intracorneal, subcorneal, and/or intraepidermal pustules with papillary dermal edema containing neutrophils and eosinophils	Associated with:^[11] Antibiotics (penicillins, sulfonamides, tetracyclines) Carbamazepine Calcium channel blockers (Diltiazem) Hydroxychloroquine	By See below - (2010). "Acute generalized exanthematous pustulosis: an unusual side effect of meropenem". Indian J Dermatol 55 (2): 176–7. DOI:10.4103/0019-5154.62759. PMID 20606889. PMC: 2887524., CC BY 1.0, https://commons.wikimedia.org/w/index.php?curid=52979729
Hypertrophic lichen planus^[12]	Classically involves shin and ankles and is characterized by hyperkeratotic plaques and nodules covered by a scale Lesions may transform into hyperkeratotic thickened, elevated, purplish or reddish plaques and nodules	Chronic pruritus Scaling May be asymptomatic	Associated with Hepatitis C virus infection^[13]	Di James Heilman, MD - Opera propria, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11509003
Sneddon–Wilkinson disease^[14]	Flaccid pustules that are often generalized and have a tendency to involve the flexural areas Annular configuration	Pruritus May be asymptomatic	Associated with: Monoclonal gammopathy, usually an IgA paraproteinemia^[15] Crohn's disease^[16] Osteomyelitis Adalimumab^[17]
Small plaque parapsoriasis^[18]	Erythematous plaques with fine scaly surface May present with elongated, finger-like patches Symmetrical distribution on the flanks Known as digitate dermatosis	Lesions may be asymptomatic May be mildly pruritic May fade or disappear after sun exposure during the summer season, but typically recur during the winter	May progress to mycosis fungoides^[19]
Intertrigo^[20]	Red and fleshy looking lesion in skin folds Itching Oozing May be sore	Pruritus Musty odor	Associated with: Infections (Fungal, bacterial, viral) Allergies Diabetes Obesity	Source: https://www.cdc.gov/
Langerhans cell histiocytosis^[21]	Scaling and crusting of scalp	Pathological fractures^[22] Visceromegaly (hepatomegaly, spleenomegaly) Chronic cough Dyspnea^[23] Lymphadenopathy	Associated with: Diabetes insipidus^[24] Pancytopenia
Tinea manuum/pedum/capitis^[25]	Scaling, flaking, and sometimes blistering of the affected areas Hair loss with a black dot on scalp in case of tinea capitis	Pruritus KOH preparation of the lesions confirms fungal infection	Associated with: Diabetes Immunosupression Intimate contact with infected person May lead to asthma exacerbation
Seborrheic dermatitis	Papulosquamous, scaly, flaky, itchy, and red rash found particularly at sebaceous gland-rich areas of the body	Pruritus	Associated with:^[26] AIDS Stress^[27] Fungal infection Fatigue Sleep deprivation Change of season Parkinson's disease Biotin deficiency	By Roymishali - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=27267929

Head

Oral lichen planus may present in one of three forms.

The reticular form is the most common presentation and manifests as white lacy streaks on the mucosa (known as Wickham's striae) or as smaller papules (small raised area). The lesions tend to be bilateral and are asymptomatic. The lacy streaks may also be seen on other parts of the mouth, including the gingiva (gums), the tongue, palate and lips.
The bullous form presents as fluid-filled vesicles which project from the surface.
The erosive form presents with erythematous (red) areas that are ulcerated and uncomfortable. The erosion of the thin epithelium may occur in multiple areas of the mouth, or in one area, such as the gums, where they resemble desquamative gingivitis. Wickham's striae may also be seen near these ulcerated areas. This form may undergo malignant transformation.

Throat

Rarely, lichen planus shows esophageal involvement, where it can present with erosive esophagitis and stricturing. It has also been hypothesized that it is a precursor to squamous cell carcinoma of the esophagus.

Genitals

Lichen planus may also affect the genital mucosa - vulvovaginal-gingival lichen planus. It can resemble other skin conditions such as atopic dermatitis and psoriasis.

Clinical experience suggests that Lichen planus of the skin alone is easier to treat as compared to one which is associated with oral and genital lesions.

Lichen planus. Adapted from Dermatology Atlas.^[1]
Lichen planus. Adapted from Dermatology Atlas.^[1]
Lichen planus. Adapted from Dermatology Atlas.^[1]
Lichen planus. Adapted from Dermatology Atlas.^[1]
Lichen planus. Adapted from Dermatology Atlas.^[1]

Treatment

Currently there is no cure for lichen planus but there are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports that lichen planus can flare up years after it is considered cured.

Medical Therapy

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

Oral retinoids
Immunosuppressant medications

Surgery

Prevention

References

↑ ^1.000 ^1.001 ^1.002 ^1.003 ^1.004 ^1.005 ^1.006 ^1.007 ^1.008 ^1.009 ^1.010 ^1.011 ^1.012 ^1.013 ^1.014 ^1.015 ^1.016 ^1.017 ^1.018 ^1.019 ^1.020 ^1.021 ^1.022 ^1.023 ^1.024 ^1.025 ^1.026 ^1.027 ^1.028 ^1.029 ^1.030 ^1.031 ^1.032 ^1.033 ^1.034 ^1.035 ^1.036 ^1.037 ^1.038 ^1.039 ^1.040 ^1.041 ^1.042 ^1.043 ^1.044 ^1.045 ^1.046 ^1.047 ^1.048 ^1.049 ^1.050 ^1.051 ^1.052 ^1.053 ^1.054 ^1.055 ^1.056 ^1.057 ^1.058 ^1.059 ^1.060 ^1.061 ^1.062 ^1.063 ^1.064 ^1.065 ^1.066 ^1.067 ^1.068 ^1.069 ^1.070 ^1.071 ^1.072 ^1.073 ^1.074 ^1.075 ^1.076 ^1.077 ^1.078 ^1.079 ^1.080 ^1.081 ^1.082 ^1.083 ^1.084 ^1.085 ^1.086 ^1.087 ^1.088 ^1.089 ^1.090 ^1.091 ^1.092 ^1.093 ^1.094 ^1.095 ^1.096 ^1.097 ^1.098 ^1.099 ^1.100 ^1.101 ^1.102 ^1.103 ^1.104 ^1.105 ^1.106 ^1.107 ^1.108 ^1.109 ^1.110 ^1.111 ^1.112 ^1.113 ^1.114 ^1.115 ^1.116 ^1.117 ^1.118 ^1.119 ^1.120 ^1.121 ^1.122 ^1.123 ^1.124 ^1.125 ^1.126 ^1.127 ^1.128 ^1.129 ^1.130 ^1.131 ^1.132 ^1.133 ^1.134 ^1.135 ^1.136 ^1.137 "Dermatology Atlas".
↑ "Mycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute".
↑ Mahajan K, Relhan V, Relhan AK, Garg VK (2016). "Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects". Indian J Dermatol. 61 (4): 375–84. doi:10.4103/0019-5154.185699. PMC 4966395. PMID 27512182.
↑ Prantsidis A, Rigopoulos D, Papatheodorou G, Menounos P, Gregoriou S, Alexiou-Mousatou I, Katsambas A (2009). "Detection of human herpesvirus 8 in the skin of patients with pityriasis rosea". Acta Derm. Venereol. 89 (6): 604–6. doi:10.2340/00015555-0703. PMID 19997691.
↑ Smith KJ, Nelson A, Skelton H, Yeager J, Wagner KF (1997). "Pityriasis lichenoides et varioliformis acuta in HIV-1+ patients: a marker of early stage disease. The Military Medical Consortium for the Advancement of Retroviral Research (MMCARR)". Int. J. Dermatol. 36 (2): 104–9. PMID 9109005.
↑ Jiamton S, Tangjaturonrusamee C, Kulthanan K (2013). "Clinical features and aggravating factors in nummular eczema in Thais". Asian Pac. J. Allergy Immunol. 31 (1): 36–42. PMID 23517392.
↑ "STD Facts - Syphilis".
↑ Neagu TP, Tiglis M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinTescu IM (2017). "Clinical, histological and therapeutic features of Bowen's disease". Rom J Morphol Embryol. 58 (1): 33–40. PMID 28523295.
↑ Murao K, Yoshioka R, Kubo Y (2014). "Human papillomavirus infection in Bowen disease: negative p53 expression, not p16(INK4a) overexpression, is correlated with human papillomavirus-associated Bowen disease". J. Dermatol. 41 (10): 878–84. doi:10.1111/1346-8138.12613. PMID 25201325.
↑ Szatkowski J, Schwartz RA (2015). "Acute generalized exanthematous pustulosis (AGEP): A review and update". J. Am. Acad. Dermatol. 73 (5): 843–8. doi:10.1016/j.jaad.2015.07.017. PMID 26354880.
↑ Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ (2002). "Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation". Am. J. Pathol. 161 (6): 2079–86. doi:10.1016/S0002-9440(10)64486-0. PMC 1850901. PMID 12466124.
↑ Ankad BS, Beergouder SL (2016). "Hypertrophic lichen planus versus prurigo nodularis: a dermoscopic perspective". Dermatol Pract Concept. 6 (2): 9–15. doi:10.5826/dpc.0602a03. PMC 4866621. PMID 27222766.
↑ Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W (2009). "Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis". Arch Dermatol. 145 (9): 1040–7. doi:10.1001/archdermatol.2009.200. PMID 19770446.
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↑ Kasha EE, Epinette WW (1988). "Subcorneal pustular dermatosis (Sneddon-Wilkinson disease) in association with a monoclonal IgA gammopathy: a report and review of the literature". J. Am. Acad. Dermatol. 19 (5 Pt 1): 854–8. PMID 3056995.
↑ Delaporte E, Colombel JF, Nguyen-Mailfer C, Piette F, Cortot A, Bergoend H (1992). "Subcorneal pustular dermatosis in a patient with Crohn's disease". Acta Derm. Venereol. 72 (4): 301–2. PMID 1357895.
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↑ Misery L, Touboul S, Vinçot C, Dutray S, Rolland-Jacob G, Consoli SG, Farcet Y, Feton-Danou N, Cardinaud F, Callot V, De La Chapelle C, Pomey-Rey D, Consoli SM (2007). "[Stress and seborrheic dermatitis]". Ann Dermatol Venereol (in French). 134 (11): 833–7. PMID 18033062.

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v t e Diseases of the skin and subcutaneous tissue (integumentary system) (L, 680-709)
Infections	Template:Navbox subgroup
Bullous disorders	acantholysis (Pemphigus, Transient acantholytic dermatosis) · Pemphigoid (Bullous, Cicatricial, Gestational) · Dermatitis herpetiformis
Inflammatory	Template:Navbox subgroup
Radiation-related disorders	Sunburn · actinic rays (Actinic keratosis, Actinic cheilitis) · Polymorphous light eruption (Acne aestivalis) · Radiodermatitis · Erythema ab igne
Pigmentation disorder	hypopigmentation (Albinism, Vitiligo) · hyperpigmentation (Melasma, Freckle, Café au lait spot, Lentigo/Liver spot, Acanthosis nigricans, Acral acanthotic anomaly)
Other skin	keratosis/hyperkeratosis (Seborrheic keratosis, Callus) · other epidermal thickening (Ichthyosis acquisita, Palmoplantar keratoderma) skin ulcer (Pyoderma gangrenosum, Bedsore) Cutaneous Markers of Internal Malignancy (Florid cutaneous papillomatosis, acanthosis nigricans, sign of Leser-Trelat) atrophic (Lichen sclerosus, Acrodermatitis chronica atrophicans) necrobiosis (Granuloma annulare, Necrobiosis lipoidica) · other granuloma (Granuloma faciale, Pyogenic granuloma) cutaneous vasculitis (Livedoid vasculitis, Erythema elevatum diutinum)
Connective tissues	collagen disease: Keloid localized connective tissue disorders: Lupus erythematosus (Discoid lupus erythematosus, Subacute cutaneous lupus erythematosus) · Scleroderma/Morphea · Linear scleroderma · Calcinosis cutis · Sclerodactyly · Ainhum
see also congenital, neoplasia

Lichen planus

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Common Causes

Causes in Alphabetical Order

Differentiating lichen planus from other Diseases

Epidemiology and Demographics

Age

Gender

Risk Factors

Natural History, Complications, and Prognosis

Diagnosis

Symptoms

Physical Examination

Skin

Trunk

Extremity

Oral cavity

Face

Lichen Planus Actinicus

Face

Trunk

Extremity

Lichen planus annular

Trunk

Lichen Planus Follicularis

Neck

Extremity

Scalp

Lichen Planus Linearis

Trunk

Extremity

Lichen Planus Verrucosus

Lichen Planus Vesicular

Trunk

Extremity

Mucosal Lichen Planus

Oral cavity

Differential diagnosis

Head

Throat

Genitals

Treatment

Medical Therapy

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

Surgery

Prevention

References

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