Lichen planus – a clinical guide

Abstract

Summary Lichen planus (LP) is a chronic lichenoid inflammatory disorder of the skin, mucosa and of the appendages. LP is classically characterized by the presence of a rich infiltration of inflammatory T cells, which migrate in the upper part of the dermis, arranged in a band‐like pattern. Different sub types of the disease have been so far described. Albeit LP is clinically well defined, the disease still represents a therapeutic enigma. Especially with regard to mucosal or scalp affecting LP types, which often present a recalcitrant and treatment unresponsive course, efficacious therapeutic options are still lacking. Thus, LP represents a disease with a high psychosocial burden. Yet, development in the deciphering of LP pathogenesis reveals possible new druggable targets, thus paving the way for future therapeutic options. In this clinical guide, we summarize the current clinical knowledge and therapeutic standards and discuss the future perspective for the management of LP.

Unmet Medical Needs in Chronic, Non-communicable Inflammatory Skin Diseases

“…Involvement of the scalp is also more often reported in female patients, with a sex ratio close to 5:1. Clinically, we recognize three major subtypes of LP: cutaneous LP (CLP), MLP, and LP of the scalp, classically called lichen planopilaris (LPP) ( 14 , 106 , 107 ). CLP is classically characterized by violaceous, polygonal, slightly scaling and extremely pruriginous flat papules, which affect mostly the extremities ( Figures 1E,F ).…”

“…MLP affects most frequently the oral mucosa. It has been more often described in female patients in the fourth decade ( 107 ). Clinically, MLP of the oral cavity is characterized by Wickham striae, erythematous macules, and, in some aggressive cases, by ulcerations ( Figure 1E ).…”

Esophageal lichen planus successfully treated with the JAK1/3 inhibitor tofacitinib

“…It can be erosive or non-erosive. Erosive LP most commonly affects the oral and genital mucosa, but can also affect the esophageal mucosa, an involvement that is often underdiagnosed [1,2]. Symptoms of esophageal LP (ELP) include dysphagia, odynophagia and weight loss [2,3].…”

“…Erosive LP most commonly affects the oral and genital mucosa, but can also affect the esophageal mucosa, an involvement that is often underdiagnosed [1,2]. Symptoms of esophageal LP (ELP) include dysphagia, odynophagia and weight loss [2,3]. Esophageal LP mostly occurs in the upper and middle third of the esophagus in middle-aged women [4] and can lead to squamous cell carcinoma [5].…”

Paradoxical lichen planus induced during anti‐IL‐17A treatment is immunologically different from spontaneously occurring lichen planus

“…While PSO is usually a chronic relapsing skin disorder with associated immune memory, immune memory is not typical for cutaneous LP, which usually shows one period of disease activity without recurrence after successful treatment with topical steroids and phototherapy. 5 Paradoxical skin reactions are one important disease group for which we have to understand the cytokine network behind. Our case study and future studies may help to identify better therapeutic strategies for these patients.…”