Update on lichen planus and its clinical variants

Abstract

Lichen planus (LP) is an inflammatory skin condition with characteristic clinical and histopathological findings. Classic LP typically presents as pruritic, polygonal, violaceous flat-topped papules and plaques; many variants in morphology and location also exist, including oral, nail, linear, annular, atrophic, hypertrophic, inverse, eruptive, bullous, ulcerative, lichen planus pigmentosus, lichen planopilaris, vulvovaginal, actinic, lichen planus-lupus erythematosus overlap syndrome, and lichen planus pemphigoides. Clinical presentation of the rarer variant lesions may be largely dissimilar to classic LP and therefore difficult to diagnose based solely on clinical examination. However, histopathological examination of LP and LP-variant lesions reveal similar features, aiding in the proper diagnosis of the disease. Management of LP and LP variants aims to control symptoms and to decrease time from onset to resolution; it often involves topical corticosteroids, but varies depending on the severity and location of the lesion. The literature contains an array of reports on the variations in presentation and successful management of LP and its variants. A familiarity with LP and its variants is important in achieving timely recognition and management of the disease.

Lichen Planopilaris in the Setting of Hair Sunscreen Spray

“…Histologic findings include a lichenoid lymphocytic infiltrate and progressive dermal fibrosis. The disease is often chronic and progressive, and achieving remission is often challenging [1].…”

“…FFA is indistinguishable from classic LPP on trichoscopy and histology, but it has a distinct clinical presentation as a band-like area of alopecia involving the frontal and frontotemporal scalp in postmenopausal Caucasian women. There is also occasional involvement of the eyebrows and eyelashes [1].…”

“…Frontal fibrosing alopecia (FFA) is a distinct disease that shares the histologic and trichoscopic features of LPP but differs in its clinical presentation in that it involves the frontal scalp and occasionally the eyelashes and eyebrows of older Caucasian women [1]. The incidence of FFA has increased over the past decade, and its development has recently been linked to regular sunscreen use [2][3][4].…”

A clitoral verrucous carcinoma in an area of lichen planus has aggressive features

“…A reduction in cancer progression could theoretically be induced by the treatment of active lichen planus or lichen sclerosis. A recent randomized controlled trial demonstrated improvements in the disease course of lichen planus with initial aggressive therapy involving oral prednisolone, with or without additional topical corticosteroids application, and maintenance therapy with weekly low-dose methotrexate when topical therapy was not adequate [13, 14]. The use of immunosuppressive agent is also often mentioned in the literature; however, they bear the risk of increased malignant transformation.…”

Erosive lichen planus: A case report

“…[1] Classic LP typically presents as pruritic, polygonal, purplish papules, and plaques (described using the 6 Ps); many variants in morphology and location also exist, including oral, nail, linear, annular, erosive, atrophic, hypertrophic, inverse, eruptive, bullous, ulcerative, LP pigmentosus, lichen planopilaris, vulvovaginal, actinic, LP-lupus erythematosus overlap syndrome, and LP pemphigoides. [2] Th e sites involved over the skin include the fl exor surfaces of the legs and arms, especially the wrists and elbows. Th e nail beds may also be aff ected with resultant ridging, grooving, pterygium, onychorrhexis, and complete loss of the nail.…”