Introduction

Lichen planus is a skin disorder of unknown aetiology, most probably being immune-mediated.

Clinical features

Features
  • itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
  • rash often polygonal in shape, with a 'white-lines' pattern on the surface (Wickham's striae)
  • Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
  • oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
  • nails: thinning of nail plate, longitudinal ridging

© Image used on license from DermNet NZ

© Image used on license from DermNet NZ

© Image used on license from DermNet NZ

Management

Management
  • topical steroids are the mainstay of treatment
  • benzydamine mouthwash or spray is recommended for oral lichen planus
  • extensive lichen planus may require oral steroids or immunosuppression