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SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences

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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, Kudakwashe K. Maloney MD, MPhil, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Mucocutaneous lichen planus (LP) is a relatively common condition with varying clinical presentations. It can present in an individual with cutaneous LP or in isolation. Mucocutaneous LP may be erosive and ulcerative with significant scarring, pain, discomfort, and dysfunction, resembling lichen sclerosus, or present with thickened / hypertrophic lesions.

See oral lichen planus for oral mucosal presentation and lichen planopilaris for scalp presentation.

Certain medications may cause a lichenoid drug eruption, which is indistinguishable from typical LP.

Codes

ICD10CM:
L43.9 – Lichen planus, unspecified

SNOMEDCT:
4776004 – Lichen planus

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Psoriasis – Look for psoriasis at other classic body sites.
  • Lichenoid drug eruption – The mucocutaneous eruption is widespread.
  • Seborrheic dermatitis (genital lesions) – Look for well-demarcated plaques with greasy scale.
  • Lichen sclerosus (vulvar lesions) – Look for porcelain white atrophic plaques with areas of hemorrhage.
  • Lichen simplex chronicus – Look for lichenification with exaggerated skin markings on glabrous areas of vulva only, often with excoriations.
  • Vulvovaginal candidiasis – Also itchy; outlying satellite papules and pustules are a diagnostic hallmark.
  • Tinea cruris – Look for annular, scaly plaques.
  • Pemphigus vulgaris – Look for erosions and blisters with positive Nikolsky's sign, Asboe-Hansen sign.
  • Secondary syphilis – Condyloma lata are moist, gray papules and plaques.
  • Mucous membrane pemphigoid – Look for blisters and erosions, scarring, and stricture formation in later stages.
  • Desquamative inflammatory vaginitis – Look for mucosal erythema, edema, erosions, and discharge.
  • Plasma cell vulvitis – Look for well-circumscribed violaceous plaque, often on the vestibule.
  • Erythema multiforme – Look for skin with target lesions, mucosal ulcers, and hemorrhagic crust.
  • Cutaneous squamous cell carcinoma – A well-demarcated scaly or hyperkeratotic plaque, or a nonhealing erosion.
  • Papular acantholytic dermatosis
  • Bullous pemphigoid
  • Recessive Dystrophic epidermolysis bullosa (vulvar lesions)
  • Junctional epidermolysis bullosa (vulvar lesions)

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.

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References

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Last Reviewed:05/06/2019
Last Updated:11/28/2021
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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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