Lichen planus in Adult
See also in: Anogenital,Nail and Distal DigitAlerts and Notices
Synopsis
Clinically, patients present with pruritic, flat-topped, pink to purple papules that are localized most commonly along the volar wrists, shins, presacral area, and hands, but may be widespread. Oral LP and/or LP involving the genitalia can occur in isolation or in patients with cutaneous disease. Lichen planopilaris, a variant of LP affecting the follicular unit, presents with perifollicular erythema and scaling and leads to scarring alopecia. (Frontal fibrosing alopecia is a variant that is seen in older women. Another rare variant is the Graham-Little-Piccardi-Lassueur syndrome.) LP can also affect the nail matrix, resulting in fissuring, longitudinal ridging, and lateral thinning of the nails.
Certain medications cause an LP-like eruption. Culprits include captopril, enalapril, labetalol, propranolol, methyldopa, calcium channel blockers, NSAIDs, chloroquine, hydroxychloroquine, quinacrine, thiazide diuretics, etanercept, infliximab, penicillamine, quinidine, and gold salts.
LP has been described in association with hepatitis C, predominantly in certain geographical areas (Japan and Mediterranean regions). Hepatitis B vaccination as well as exposure to other bacteria and viruses has also been associated with LP in the literature. Oral LP may occur on mucosal surfaces apposed to amalgams and other dental restorative materials.
Codes
ICD10CM:L43.9 – Lichen planus, unspecified
SNOMEDCT:
4776004 – Lichen planus
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
In any location, consider drug-induced LP / lichenoid drug eruption. Characteristics of lichenoid drug reaction, as opposed to non-drug-associated LP, include older mean age, more generalized distribution, paucity of Wickham's striae, frequent photodistribution, sparing of mucous membranes, and distinct histologic characteristics.Differential diagnosis of cutaneous LP:
- Psoriasis
- Subacute cutaneous lupus erythematosus
- Chronic graft-versus-host disease
- Granuloma annulare
- Sarcoidosis
- Warts
- Pityriasis rosea
- Secondary syphilis (palm and sole lesions)
- Lichen simplex chronicus
- Prurigo nodularis
- Lichen amyloidosis
- Kaposi sarcoma
- Tinea corporis
- Lichen nitidus
- Lichen spinulosus
- Lichenoid keratosis
- Erythema dyschromicum perstans
- Mycosis fungoides
- Oral candidiasis
- Leukoplakia
- Pemphigus vulgaris
- Seborrheic dermatitis (genital lesions)
- Lichen sclerosus (vulvar lesions)
- Recessive dystrophic epidermolysis bullosa (vulvar lesions)
- Junctional epidermolysis bullosa (vulvar lesions)
- Migratory glossitis (geographic tongue)
- Secondary syphilis
- Alopecia areata
- Seborrheic dermatitis
- Discoid lupus erythematosus
- Pseudopelade of Brocq
- Other scarring alopecias
- Alopecia areata, which has specific nail manifestations
- Onychomycosis
- Psoriasis
Best Tests
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Management Pearls
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Therapy
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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.Subscription Required
References
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Last Reviewed:05/06/2019
Last Updated:11/28/2021
Last Updated:11/28/2021
Lichen planus in Adult
See also in: Anogenital,Nail and Distal Digit