Diagnosis and treatment of lichen planus

Richard P Usatine, Michelle Tinitigan

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Lichen planus is a chronic, infammatory, autoimmune disease that affects the skin, oral mucosa, genital mucosa, scalp, and nails. Lichen planus lesions are described using the six P's (planar [fat-topped], purple, polygonal, pruritic, papules, plaques). Onset is usually acute, affecting the fexor surfaces of the wrists, forearms, and legs. The lesions are often covered by lacy, reticular, white lines known as Wickham striae. Classic cases of lichen planus may be diagnosed clinically, but a 4-mm punch biopsy is often helpful and is required for more atypical cases. High-potency topical corticosteroids are first-line therapy for all forms of lichen planus, including cutaneous, genital, and mucosal erosive lesions. In addition to clobetasol, topical tacrolimus appears to be an effective treatment for vulvovaginal lichen planus. Topical cortico-steroids are also first-line therapy for mucosal erosive lichen planus. Systemic corticosteroids should be considered for severe, widespread lichen planus involving oral, cutaneous, or genital sites. Referral to a dermatologist for systemic therapy with acitretin (an expensive and toxic oral retinoid) or an oral immunosuppressant should be considered for patients with severe lichen planus that does not respond to topical treatment. Lichen planus may resolve spontaneously within one to two years, although recurrences are common. However, lichen planus on mucous membranes may be more persistent and resistant to treatment.

Original languageEnglish (US)
Pages (from-to)53-60
Number of pages8
JournalAmerican Family Physician
Volume84
Issue number1
StatePublished - Jul 1 2011

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Lichen Planus
Therapeutics
Skin
Adrenal Cortex Hormones
Mucous Membrane
Clobetasol
Acitretin
Oral Lichen Planus
Poisons
Retinoids
Mouth Mucosa
Tacrolimus
Immunosuppressive Agents
Nails
Scalp
Wrist
Forearm
Autoimmune Diseases
Leg
Referral and Consultation

ASJC Scopus subject areas

  • Family Practice

Cite this

Diagnosis and treatment of lichen planus. / Usatine, Richard P; Tinitigan, Michelle.

In: American Family Physician, Vol. 84, No. 1, 01.07.2011, p. 53-60.

Research output: Contribution to journalArticle

Usatine, RP & Tinitigan, M 2011, 'Diagnosis and treatment of lichen planus', American Family Physician, vol. 84, no. 1, pp. 53-60.
Usatine, Richard P ; Tinitigan, Michelle. / Diagnosis and treatment of lichen planus. In: American Family Physician. 2011 ; Vol. 84, No. 1. pp. 53-60.
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