Lichen Planus
Symptoms
Lichen planus presents as pruritic, flat‑topped, purple papules and plaques with fine white lines (Wickham striae). Common sites include wrists, ankles, lower back, and mucous membranes. Oral involvement causes painful white lacy patches or erosions. Nail lichen planus leads to thinning, ridging, and potential nail loss. Chronic disease can result in post‑inflammatory hyperpigmentation.
Cause
The condition arises from an immune‑mediated attack on basal keratinocytes, though the trigger is often unknown. Associations exist with hepatitis C infection and certain medications (e.g., ACE inhibitors, antimalarials). Genetic predisposition and stress may influence susceptibility. Oral lichen planus has a small but notable risk of malignant transformation over time. Mucosal trauma can exacerbate lesions.
Treatment
High‑potency topical corticosteroids reduce cutaneous inflammation. Intralesional steroids or systemic agents (e.g., oral corticosteroids, acitretin, or cyclosporine) treat resistant cases. For oral disease, topical corticosteroid gels, tacrolimus, or systemic immunosuppressants are used. Phototherapy offers an alternative for widespread plaques. Regular oral examinations monitor for malignant change.
Dr. Beth Schulz-Butulis
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