Lichen Planus

Lichen planus is an inflammatory disorder of unknown aetiology characterised by pruritic violaceous flat-tipped papules of the skin, mainly on the wrists and legs.

Clinical features

• Young and middle-aged adults

• 4 Ps—papule, purple, polygonal, pruritic

• Small, shiny, lichenified plaques, white lacy lines

• Symmetrical and flat-tipped

• Flexor surfaces: wrists, forearms, groin, ankles

• Can affect oral mucosa—white streaks or papules or ulcers

• Can affect nails, scalp and genital mucosa

Management

• Explanation and reassurance

• Usually resolves over months, leaving discoloured marks without scarring

• Recurrence rare

• Asymptomatic lesions require no treatment

• If symptomatic (e.g. itching):

  • – topical moderate to very potent steroids (may use occlusive dressing)

  • – intralesional corticosteroids for hypertrophic lesions

• Oral prednisolone if not successful or refer for expert advice