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

Lichen planus in Adult

See also in: Anogenital,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 is most common in adults in the fourth to sixth decades of life, but it may occur at any age. There is no known predilection for either sex or ethnicity. LP is estimated to occur in < 1% of the population.

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.


L43.9 – Lichen planus, unspecified

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 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
  • Common wart
  • Pityriasis rosea
  • Secondary syphilis (palm and sole lesions)
  • Lichen simplex chronicus
  • Prurigo nodularis
  • Lichen amyloidosis
  • Non-AIDS Kaposi sarcoma
  • Tinea corporis
  • Lichen nitidus
  • Lichen spinulosus
  • Lichenoid keratosis
  • Ashy dermatosis
  • Cutaneous T-cell lymphoma
Differential diagnosis of oral and mucosal LP:
  • 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
Differential diagnosis of lichen planopilaris:
  • Alopecia areata
  • Seborrheic dermatitis
  • Discoid lupus erythematosus
  • Pseudopelade of Brocq
  • Other scarring alopecias
Differential diagnosis nail apparatus LP:
  • Alopecia areata, which has specific nail manifestations
  • Onychomycosis
  • Psoriasis

Best Tests

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Management Pearls

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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:07/09/2023
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Patient Information for Lichen planus in Adult
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Lichen planus in Adult
See also in: Anogenital,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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