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Lichen planus - Anogenital in
See also in: Overview,Nail and Distal Digit
Other Resources UpToDate PubMed

Lichen planus - Anogenital in

See also in: Overview,Nail and Distal Digit
Contributors: Jeffrey M. Cohen MD, Lauren Strazzula MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


Lichen planus (LP) is a condition in which autoreactive T lymphocytes attack basal keratinocytes in the skin, mucous membranes, hair follicles, and/or nail units. The etiology is unclear, but viruses, medications, and contact allergens have all been implicated. LP may solely involve the penis but can also affect the skin more broadly, and can also affect hair follicles, the nail unit, and mucous membranes. See oral lichen planus for oral mucosal presentation and lichen planopilaris for scalp presentation.

Clinically, LP presents with flat-topped, reddish to purple papules. Penile LP most commonly presents on the glans and is often annular in configuration. Papules and plaques can erode, resulting in significant pain, scarring, and impairment of function.

Drugs causing LP-like eruptions (lichenoid drug reactions) include antihypertensives (angiotensin-converting enzyme [ACE] inhibitors: captopril and enalapril; beta blockers: propranolol and labetalol), thiazide diuretics, antimalarials (quinidine and hydroxychloroquine), penicillamine, NSAIDs, griseofulvin, tetracycline, antiepileptics, and many other drugs.

LP can spontaneously resolve, usually after a year, or follow a remitting or chronic course. LP of mucosal sites tends to be more chronic and treatment resistant than cutaneous LP.


L43.9 – Lichen planus, unspecified

4776004 – Lichen planus

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Psoriasis
  • Sarcoidosis
  • Secondary syphilis
  • Lichen nitidus
  • Male genital candidiasis
  • Seborrheic dermatitis (genital lesions)
  • Lichen sclerosus (Balanitis xerotica obliterans)
  • Granuloma annulare
  • Lichen simplex chronicus
  • AIDS-associated Kaposi sarcoma
  • Pemphigus vulgaris
  • Lichenoid drug eruption
  • Mucous membrane pemphigoid
  • Erythema multiforme
  • Cutaneous squamous cell carcinoma
  • Discoid lupus erythematosus
  • Scabies
  • Molluscum contagiosum
  • Bowenoid papulosis
  • Papular acantholytic dermatosis
For erosive lesions:
  • Zoon plasma cell balanitis
  • Erythroplasia of Queyrat
  • Erosive balanitis
  • Erosive Fixed drug eruption

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:05/06/2019
Last Updated:05/06/2019
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Lichen planus - Anogenital in
See also in: Overview,Nail and Distal Digit
A medical illustration showing key findings of Lichen planus (Overview) : Forearm, Koebner phenomenon, Polygonal configuration, Purple color, Wickham striae, Widespread distribution, Wrist, Anterior lower leg, Pruritus
Clinical image of Lichen planus - imageId=21134. Click to open in gallery.  caption: 'Flat-topped violaceous polygonal papules, some annular, with fine white scale at the wrist.'
Flat-topped violaceous polygonal papules, some annular, with fine white scale at the wrist.
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